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DENTAL  PATHOLOGY  AND 
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?QUIZ    COMPKNDS?     No.  13 

A  COMPEND  OF 

DENTAL  PATHOLOGY  AND 
DENTAL  MEDICINE 


CONTAINING  THE   MOST   NOTEWORTHY  POINTS   UPON 

THE   SUBJECTS   OF  INTEREST  TO  THE  DENTAL 

STUDENT  AND  A  SECTION  ON 

EMERGENCIES 


BY 

GEO.  W.  WARREN,  A.M.,  D.D.S. 

PROFESSOR  OF   PRINCIPLES  AND   PRACTICE  OF    OPERATIVE    DENTISTRY,   PENNSYLVANIA 
COLLEGE  OF   DENTAL  SURGERY,   PHILADELPHIA 


FOURTH    EDITION.       ILLUSTRATED 


PHILADELPHIA 

P.    BLAKISTON'S    SON    &  CO 

No.  1012  Walnut  Street 
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Copyright,  1903,  by  P.  Bi^akiston's  Son  &  Co. 


Prkss  of 

Rkpokt  Publishing  CoMPAiSv 

Lebanon,  Pa. 


iil 

'St 

cr> 


TO    MV    FRIEND 

PROFESSOR  C.  N.  PEIRCE,  D.D.S. 


NOTE. 

One  of  the  first,  and  sometimes  most  difficult,  les- 
sons the  student  has  to  learn  is  how  to  study,  and 
many  of  our  text-books  are  so  voluminous  that  they 
prove  a  source  of  embarrassment  to  one  just  begin- 
ning his  professional  studies.  Compends  are  de- 
signed to  facilitate  these  labors,  and  if  properly 
used  as  aids  to  more  elaborate  works,  they  have  a 
special  value. 

The  author  hopes  that  it  will  be  found  useful  to 
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view  of  the  subject  to  be  studied  in  larger  works  and 
as  a  book  for  review  giving  a  thorough  outline  of 
work  which  has  been  done. 


CONTENTS. 


PAGE 

Anatomical  and   Physiological   iNTuoDrcTiox ^ 

Development  of  the  Teeth, ^ 

Structure  of  the  Teeth 14 

Anatomy   of   the   Teeth !•' 

Decalcification  of  the   Temporarj^  Teeth '^^ 

Dental    Pathology    and    Therapeutics ^'-^ 

Inflammation, ; ^^ 

Diseases  of  the  Dental  Pulp  and  Membrane, ^^ 

Diseases  of  the  Hard  Dental  Structure, 4*.> 

Injuries  and  Diseases  of  the  :Maxillary  P.ones 57 

Defects  of  the  Palatine  Organs ^5 

Extraction  of  Teeth, ^'^^ 

Deposits  upon  the  Teeth, "^ 

Dental    Medicine, ^4 

Narcotics  and  Hypnotics ^4 

Analgesics  or  Anodynes, *^ 

Anesthetics, '•' 

Stimulants, -^^ 

Tonics, 1^^ 

Sedatives, H-^ 

Antipyretics, H**^ 

Irritants 120 

Astringents, 123 

Styptics  and  Hemostatics, 126 

Escharotics  or  Caustics, 12'i' 

Antizymotics   (Antiseptics  and  Disinfectants), 131 

Cathartics, 143 

Emergencies,         . 14^ 

Weights  and  Measures, ' l'if^2 

Index, l'*^^ 

vii 


ABBREVIATIONS. 


ABBREVIATION.  LATIN. 

aa Ana     (G.), 

Ad   saturand.,    .      .      .Ad    saturandum,     . 
Ad   lib.,        ....   Ad    libitum, 
Aq.,  .      .       .      .      ^   Aqua,     .... 

Aq.    dest.,    ....   Aqua    destillata,     . 

Comp., Compositus, 

Ext., Extractum,    . 

F.   or  Ft.,    .      .      .      .Fiat  vel   flant, 

Garg., Gargarysma,     . 

Gr.,         Granum,    vel   giana, 

Gtt Gutta,  vel  gutt^,    . 

Infus., Infusum,    . 

M., Misce 

Mist Mistura,       .      .      . 

0-. Octarius, 

Pil Pilula,    vel    pilulae, 

Pulv., Pulvis,  vel  pulveres, 

Q-    s., Quantum    sufficit, 

IJv Recipe, 

S., Signa,     .... 

Spts., Spiritus, 

ss., Semis,     .... 

Syi., Syrupus. 

Tinct., Tinctura,     . 

It) Libra 

*. Uncia,    .... 

3» Drachma,     . 

9. Scrupulus, 

iE Fluid  uncia, 

f3, Fluid   drachma, 

T(\^,     ,      ,      .      ,      .      .   Minim, 


ENGLISH. 

.  Of  each. 

.  Until   saturated. 

.  At   pleasure. 

.  Water. 

.  Distilled   water. 

.  Compound. 
.  An  extract. 

.  Let  there  be  made. 

.  A  gargle. 

.  A  grain,   or  grains. 

.  A  drop,  or  drops. 

An    infusion. 

.  Mix. 

.  A    Mixture. 

.  A    pint. 

.  A  pill,  or  pills. 

A   powder,    or    powders. 

.  A    sufficient    quantity. 

.  Take. 

.  Write    directions. 

.  Spirits. 

.  The  half. 

.  Syrup. 

.  A    tincture. 

.  A  pound. 

.  An  ounce. 

.  A   drachm. 

.  A   scruple. 

.  A  fluid  ounce. 

.  A  fluid  drachm. 

.  A  drop. 


Vlll 


DENTAL    PATHOLOGY    AND 
DENTAL    MEDICINE. 


ANATOMICAL  AND  PHYSIOLOGICAL 
INTRODUCTION. 


DEVELOPMENT   OE   THE   TEETH. 

A  Tooth. — It  is  sometimes  difficult  to  give  in  a  few  words 
a  satisfactory  definition  to  a  term.  This  it  seems  has  been  the 
case  with  the  word  tooth.  Some  writers  say  "a  tooth  is  a  hard 
substance  situated  in  the  anterior  portion  of  the  alimentary 
canal;"  others  define  it  as  "a  papilla  of  the  raucous  membrane  of 
the  gum,  which  has  undergone  a  characteristic  development." 
Again  it  is  described  "a  bony  structure  implanted  in  the  alveoli 
along  the  margins  of  the  jaw."  Broomell,  in  his  excellent  work 
on  Dental  Anatomy  and  Histology,  says  "a  tooth  is  a  specialized 
organ  for  the  seizure  and  mastication  of  food,  placed  at  the 
entrance  of  the  alimentary  canal."  But  as  a  little  fuller  and 
more  satisfactory  explanation  of  the  term  we  might  accept  the 
following :  "A  tooth  is  a  small  organ,  bony  in  character,  which 
normally  occupies  an  alveolar  cavity  of  the  upper  or  lower 
jew.  Collectively  the  teeth  are  the  hardest  portion  of  the  body 
and  are  the  principal  organs  of  mastication."  The  developmen^" 
of  these  organs  is  a  most  curious  and  interesting  process,  com- 
mencing very  early  in  fetal  life. 

The  Enamel  Organ. — During  the  seventh  week  of  fetal 
life  there  appears  on  the  border  of  the  jaw  a  ridge  of  epithe- 

9 


10 


DENTAL  PATHOLOGY   AND  DENTAL  MEDICINE. 


lium,  known  as  the  dental  ridge;  from  this  the  epithelial  folli- 
cles are  deflected  inward,  and  later  on  form  what  is  known  as 
the    Enamel    Organ.      Each    follicle   represents    an    individual 

.a 


Fig.  1. 


Fig.  2. 

Figs.  1  and  2. — Theee  Stages  in  Developing  Enamel  Organs. 
a.  Dental  ridge,     c.  Infant  layer  of  cells,     d.  Epithelial  cord.  e.  Stellate 
reticulum,     f.  Dentinal  papilla,     g.  Inner  tunic,     h.  Outer  tunic,     i. 
Transverse  section  of  vessel.     7c.  Forming  bone. 

tooth.     The  cells  active  in  the  formation  of  the  enamel   are 
known  as  enamelblasts  or  amelloblasts.. 

The  Dentine  Organ. — A  papilla  arises  in  the  dermal  tissue, 


DEVELOPMENT  OF  THE  TEETH. 


11 


at  a  point  immediately  in  contact  with  the  rounded  portion  of 
the  enamel  organ — ^that  is,  from  below  in  the  lower  jaw,  and 
from  above  in  the  upper  Jaw.  Simultaneously,  the  bottom  of 
the  enamel  organ  is  rendered  concave,  in  correspondence  to  the 
form  and  size  of  the  dentine  papilla,  covering  it  like  an  in- 
verted cup :  this  dentine  bulb  begins  to  assume  the  form  of  the 
tooth  from  the  ninth  to  the  tenth  week.    (See  Figs.  1  and  2.) 

By  the  end  of  the  twelfth  week  the  follicles  of  the  first, 
or  deciduous,  set  of  teeth  are  completed. 


Fig.  3. 

a.  Outer  layer  of  mucous  membrane.  6^  6.  Calcifying  bone.  c.  Epithelial 
cord.  d.  Dentinal  papilla,  e.  Calcifying  enamel,  f.  Enamel  germ. 
h.  Permanent  tooth  germ. 

When  the  follicle  is  completed,  it  is  developed  by  vascu- 
lar tissue,  forming  the  dental  sac;  this  is  about  the  fourteenth 
week.  During  this  process  of  dentification  there  appears  in  the 
jawbone  a  groove  within  which  the  dentinal  follicles  rest. 


Follicular  Development  of  the  Permanent  Teeth. 

The  follicles  of  the  permanent  teeth  begin  to  develop 
about  the  seventeenth  week  of  embryo  life;  of  these,  the  first 
to  become  completed  are  those  of  the  four  first  molars,  at  ahout 
the  twentieth  weeh;  these  are  followed  by  the  follicles  of  the 
teeth  anterior  to  them,  which  are  completed  before  birth. 


12 


DENTAL   PATHOLOGY   AND  DENTAL   MEDICINE. 


The  ten  anterior  teeth  originate  from  the  necks  of  the 
primitive  follicles,  while  the  hud  of  the  follicle  of  the  first  per- 
manent molar  originates  from  the  epithelial  lamina,  as  do  the 
deciduous  teeth,  and  back  of  all  the  follicles  of  the  temporary- 
set. 

The  follicle  of  the  second  permanent  molar  originates 
from  the  neck  of  the  follicle  of  the  first  molar,  and  begins  to 


Tooth   sac  of   Per- 
manent   Tooth. 


Periosteum  and 
Mucous  Mem- 
brane from 
Hard    Palate. 


Gubernaculum. 


Tooth  sac  for  Per- 
manent First 
Molar. 


Fig.   4. — Tooth-sacs  of  Deciduous  Teeth. 

form  about  the  twelfth  week  after  birth.  This  budding  process 
is  illustrated  in  Fig.  3.  It  is  also  very  clearly  shown  in  Fig. 
4  which  represents  a  dissection  made  by  Prof.  Broomell. 

The  follicle  of  the  third  permanent  molar  begins  to 
develop  about  the  third  year  after  birth,  budding  from  the  neck 
of  the  follicle  of  the  second  molar,  and  is  in  its  follicular  evo- 
lution about  three  years,  thus  loosening  its  connection  with 
the  epithelial  band  at  about  the  sixth  year.     It  is  then  from 


DEVELOPMENT   OF  THE   TEETH.  13 

twelve  to  fifteen  yeai's  coiuing-  to  such  maturity  as  to  emerge 
from  the  giim. 

Calcification. 

The  Calcification  of  the  Enamel. — The  deposition  of  lime 
salts.,  which  gives  the  teeth  their  characteristic  hardness  and  is 
termed  calcification,  commences  at  the  surface  of  the  dentine 
and  proceeds  outward,  each  enamel  rod  taking  the  form  of  the 
cell,  which  in  their  compactness  take  on  various  shapes,  usually, 
however,  hexagonal,  and  the  lime  salts  from  each  are  depos- 
ited in  close  contact  with  each  contiguous  cell;  there  being  but 
a  very  small  amount  of  animal  matter,  the  cement  material  be- 
tween them.  When  it  is  completed  the  enamel  organ  disappears 
and  nourishment  to  the  enamel  can  only  be  had  through  the 
surface  lying  nearest  to  the  dentine,  which  is  accomplished 
through  osmotic  action. 

The  calcification  of  the  dentine  commences  on  the  surface 
next  to  the  enamel  organ,  and  progresses  from  without  inward, 
this  being  the  point  where  mineralization  begins  in  the  tooth 
structure.  The  working  cells  of  the  dentine,  the  odontoblasts. 
throw  out  processes  around  which  the  lime  salts  are  deposited, 
the  processes  leng-thening  with  the  thickening  of  the  cap  of 
dentine;  thus  forming  the  tubular  structure  of  dentine.  The 
processes  occupying  the  tubules  of  the  dentine  are  simply  pro- 
toplasmic prolongations.  As  age  advances,  both  the  tubuli  and 
fibrilli  decrease  in  size,  and  in  old  age  the  extremities  are 
nearly  or  wholly  obliterated. 

The  Cementum. — The  cells  active  in  the  formation  of  the 
Cementum  are  termed  Cementohlasts.  This  structure  is  formed 
from  the  pericemental  membrane,  remaining  as  the  residue  of 
the  dental  sac,  and  becomes  adherent  to  the  previously  calcified 
dentine. 

Calcification  commences  about  the  seventeenth  week  of  fetal 
life,  in  the  temporary  incisors,  and  in  the  remaining  temporary 
teeth  during  the  seventh  month;  in  the  first  permanent  molars 


14  DENTAL  PATHOLOGY  AND  DENTAL  MEDICINE. 

during  the  eighth  month;  during  the  first  year  in  the  perma- 
nent incisors  and  cuspids;  the  third  year  in  the  bicuspids,  the 
fifth  year  in  the  second  molars,  and  during  the  eighth  year  in 
the  third  molars. 

It  requires  about  two  years  for  calcification  to  become  com- 
pleted in  a  deciduous  tooth,  and  about  ten  years  in  a  perma- 
ment  tooth.     The  progress  of  calcification  is  shown  in  Fig.  5. 


STRUCTUEE  OF  THE  TEETH. 

Physiologically,  the  teeth  are  divided  into  the  enamel,  den- 
tine, cementum,  pulp,  and  pericemental  membrane. 

The  enamel  covers  the  crown  portion  of  the  dentine.  It 
is  the  hardest  and  most  dense  of  all  organic  substances,  hence 
it  serves  as  a  protection  to  the  dentine  from  abrasion,  and 
forms  a  greater  resistance  to  mechanical  force  and  the  action 
of  acids  as  well  as  to  beautify  the  teeth. 

The  dentine  gives  the  typical  form  of  the  teeth.  The  chief 
characteristics  which  adapt  it  to  constitute  the  main  body  of 
the  tooth  structure  are  its  density  and  vitality.  While  it  en- 
closes within  it  the  pulp,  it  is  itself  enclosed  on  the  crown  by 
the  enamel  and  on  the  root  by  the  cementum.  Frequently  im- 
perfect dentine  formations  occur,  known  as  interglobular 
spaces;  these  are  found  near  the  surface  of  the  enamel  and  are 
due  to  malnutrition  during  the  period  of  calcification.  Pits 
in  the  enamel  will  very  often  be  found  accompanying  these 
interglobular  spaces,  and  are  due  to  the  same  causes. 

The  cementum,  a  somewhat  dense  substance,  covers  the 
root  portion  of  the  dentine.  Its  special  use  is,  by  being  inter- 
mediate in  the  density  of  its  structure,  to  form  a  union  of  the 
soft  tissue  of  the  root  membrane  with  the  dentine,  thus  aiding 
the  pulp  in  nourishing  the  tooth,  and  preserving,  in  a  measure, 
the  vitality  of  the  tooth  after  the  pulp  may  have  been  de- 
vitalized. 


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16 


DENTAL  PATHOLOGY  AND  DENTAL  MEDICINE. 


The  pulp  is  enclosed  by  the  dentine,  and  like  the  dentine 
represents  the  shape  of  the  tooth  only  in  a  more  diminished 
size.  It  is  composed  of  nerve,  vein,  artery  and  formative  tissue. 
This  body  is  the  mere  shrunken  condition  to  which  the  tooth 
germ,  or  dental  papilla,  is  reduced,  after  it  has  normally  accom- 
plished the  work  of  dentification. 


Fig.    6. — Repkesents    Vektical,    Sections    of    the    Uppek    Cuspid    and 

MOLAE     TeETH^     showing     THE     RELATION     AND     RELATIVE     THICKNESS 

OF   THE   Hard   Dental   Tissues  ;    also    Size^    Shape   and   Location 
op  the  Pulp  Chamber. 

E.  Enamel.     C.  Cement.     D.  Dentine.     P.  Pulp  cavity. 


The  pulp  is  exquisitely  sensitive  and  highly  vascular;  it  is 
of  a  reddish  gray  color  and  is  enveloped  in  an  exceedingly  deli- 
cate membrane,  which  is  continuous  with  the  peridental  mem- 
brane and  is  adherent  to  the  wall  of  the  pulp  cavity. 

The  pulp  is  divided  into  two  portions — the  crown  or  body, 
which  occupies  the  crown  cavity,  and  the  extremities,  which 
occupy  the  root  canal. 

In    advanced    age    this    body    often    undergoes    considerable 


STRUCTURE   OF   THE   TEETH. 


17 


change;  the  size  is  sometimes  much  diminished  or  is  entirely 
replaced  by  calcic  matter,  while  again  it  is  found  as  a  shriveled 
and  nearly  insensitive  mass. 

This  degeneration  is  due  to  the  mild  but  almost  constant 
irritation  and  shock  to  which  the  teeth  are  liable  at  this  time 
of  life,  owing  to  their  w^orn  and  abraded  condition.     If  then. 


Main  Nerve- 
trunk. 


Main  Blood- 
vessels. 


Branch  ing 
of  Main 
Nerve- 
trunk  into 
Single  Fi- 
bers. 


Bra  n  ehi  ng 
of  Main 
Blood-vt'S- 
sels  into 
Capilla- 
ries. 


Fig.   7. — Distribution  of  Blood-vessels  and  Nerves   to  the   Pulp  of 
Human   Molar. —  (Broomell,   after  Gysi.)      x  20. 

the  irritation  is  mild,  and  the  patient  of  a  calcic  diathesis,  this 
further  deposit  of  lime  salts  is  made,  and  the  pulp  diminished 
in  size  in  consequence.  But  where  the  irritation  is  more  severe 
it  will  result  in  congestion  and  death  of  the  pulp. 

The  pericemental  membrane  is,  as  the  name  implies,  the 
membrane  which  surrounds  or  invests  the  roots  of  the  teeth.  Ifc 
is  a  richly  vascular,  fibrous  structure,  and  is  the  nutrient  organ 
of  the  cementum.    It  is  also  the  organ  of  touch  in  the  tooth,  a8 


18  DENTAL  PATHOLOGY  AND  DENTAL  MEDICINE. 

through  the  nerves  of  this  membrane  every  impression  upon  the 
tooth  is  reported  to  the  brain.  It  serves,  too,  to  unite  the  tooth 
to  the  alveolus  by  its  continuation  throughout  the  alveolar 
cavities  or  sockets,  and  is  connected  at  the  dental  foramen  with 
the  pulp,  as  previously  stated. 

The  peridental  membrane  also  serves  as  a  cushion,  permit- 
ting a  certain  passive  motion  by  v^hich  the  teeth  are  protected 
from  injury  by  blows  and  concussions  which  they  are  apt  to 
receive  during  the  performance  of  their  peculiar  function  of 
tearing  and  grinding  during  the  process  of  mastication. 

Nutrition  of  the  Teeth. — As  has  been  indicated,  the  pulp 
owing  to  its  very  intimate  relation  to  the  dentine,  is  the  prin- 
ciple source  of  blood  and  nerve  supply  to  that  structure.  His- 
tologists  show  us  that  the  dental  tubules  or  tubuli  open  freely 
upon  the  walls  of  the  pulp  cavity,  and  are  therefore  brought 
into  direct  communication  with  the  pulp.  These  tubuli  as  they 
radiate  towards  the  enamel  and  cementum,  gradually  diminisli 
in  size  and  give  off  numerous  branches  which  anastomose  with 
those  of  neighboring  tubuli,  or  they  may  gradually  disappear; 
or,  as  they  sometimes  do,  enter  the  enamel  or  cementum  layers 
and  through  them,  these  tissues  are  nourished  by  osmotic  action. 
Jt  is  through  this  plasmic  material  which  invades  the  tubular 
substance,  that  the  tooth  receives  its  nourishment. 

The  cementum  may  be  largely  excluded  from  tlie  above  as 
this  structure  is  principally  nourished  by  the  pericemental 
membrane.  The  cementum  is  but  a  slight  modification  of  bone 
structure;  it  has  the  little  lakes  or  lacunae,  filled  with  protoplas- 
mic material,  and  small  radiating  canals  or  canaliculi,  which 
comtmunicate  with  the  neighboring  lacunae.  These  little  lakes 
are  supplied  with  nutrient  material  principally  from  the  arterial 
circulation  of  the  pericemental  membrane.  As  previously 
stated,  however,  the  dentinal  tubuli  do  sometimes  enter  the  ce- 
mentum and  then  unite  with  the  nearby  canalicidi  and  thus 
become  involved  in  a  measure  in  the  nourishment  of  this 
structure. 


ANATOMY  OF   THE   TEETH.  19 


ANATOMY  OF  THE  TEETH. 

Primary  and  Permanent  Dentures. 

Anatomically,  tlie  teeth  are  divided  into  three  parts,  the 
crown,  neck,  and  root,  the  crown  being  that  portion  which  pro- 
jects freely  into  the  mouth;  the  neck  is  surrounded  by  the 
gums,  and  the  root  is  that  portion  covered  by  the  alveolar  pro- 
cess of  the  jaw  and  by  which  the  whole  tooth  is  held  securely  in 
position.  In  old  age  it  is  not  unusual  for  the  gums  to  recede, 
exposing  the  neck,  and  sometimes  a  part  of  the  root  is  exposed 
in  consequence  of  atrophy  of  the  alveolar  process.  The  teeth 
are  classified  into  two  general  groups,  the  simple,  those  having 
but  one  root  and  cusp,  and  the  complex,  or  those  having  two  or 
more  roots  and  cusps.  Collectively  as  dentures  there  are  also 
two  divisions — the  first  is  called  the  deciduous  or  temporary 
denture,  designed  to  serve  the  needs  of  early  childhood.  The 
second  is  termed  the  permanent  set  or  denture. 

The  temporary  denture  consists  of  twenty  teeth,  divided 
into  three  groups — the  incisors,  cuspids,  and  molars.  The  rela- 
tive position  and  number  these  groups  bear  to  one  another  is 
expressed  in  the  following  formula: — 

M^  M,  CI2 1,  I  I,  lo  C  M,  M^. 

In  the  temporary  teeth  the  proportion  of  the  length  to  the 
width  is  marked,  they  being  somewhat  shorter  than  their  suc- 
cessors, the  permanent  teeth.  The  color  of  the  temporary 
teeth  is  of  a  milky  or  bluish  white,  while  that  of  the  perma- 
nent presents  a  yellowish  appearance.  In  determining  be- 
tween the  temporary  and  permanent  teeth  the  observer  will 
be  aided  by  the  relative  size  and  color,  and  by  remembering 
that  the  former  are  somewhat  loose,  and  have  a  marked  depres- 
sion at  the  neck,  just  at  the  union  of  the  enamel  and  cementum. 

The  permanent  denture  consists  of  thirty-two  teeth,  which 


20 


DENTAL  PATHOLOGY  AND  DENTAL  MEDICINE. 


are  divided  into  four  groups,  namely:  incisors  (cutting),  cus- 
pids (tearing),  bicuspids  (crushing),  and  molars  (grinding), 
according  to  the  following  formula: — 


M3  M2  M,  BC,  BC,  C  I,  I, 
JVIgM^M^BC^BC^CI,!, 


I,  I,  C  BC,  BC2  M,  M,  M3 
I.LCBC.BaM^M^Mg 


The  relation  between  the  permanent  and  temporary  teeth  is 
shown  in  the  accompanying  diagram.  Fig.  8. 

The  anterior  twenty  teeth,  namely,  the  incisors,  cuspids, 
and  bicuspids,  each  have  one  root,  except  the  first  upper  bicus- 


3  3 


'        4-      2      2       At      '7 

Fig.   8.* — The   Figures   1,  2,   3,  etc.^   Indicate  the  Groups   of   Teeth 
AND  THE  Order  of  their  Appearance. 


pid,  which  in  about  eighty  per  cent,  has  two  roots,  one  labial 
and  one  palatine.  The  roots  of  the  upper  incisors  are  rounded; 
those  of  the  bicuspids  are  flattened  laterally.  The  roots  of  the 
lower  incisors  are  the  most  flattened,  while  the  root  of  the  cus- 
pid combines  partially  the  roundness  of  the  incisor  and  the  flat- 
ness of  the  bicuspid.  The  upper  molars  have  three  roots  each, 
two   buccal   and   one   palatine,   which   are   usually   of   a   round 

*Taken  from  "Diseases  of  the  Digestive  Organs  in  Infancy  and  Child- 
hood,"  by  Dr.   Louis  Starr. 


ANATOMY   OF   THE   TEETH. 


21 


shape.  While  the  lower  molars  have  but  two  roots,  one  an- 
terior and  one  posterior,  these  are  laterally  flattened,  and  extend 
from  the  buccal  to  the  lingual  surface  of  the  tooth.  The  roots 
of  the  third  molar  or  wisdom  tooth  are  subject  lo  the  same 
rules  as  those  of  other  molars,  but  they  are  subject  to  a  great 
number  of  exceptions. 

The  crowns  of  the  teeth  present  several  surfaces  for  ex- 
amination, which  are  named  according  to  their  position  and 
use.  Those  of  the  incisors  and  cuspids  presenting  toward  the 
lips  are  called  labial  surfaces;  while  the  same  outer  surfaces  of 


Fig.  9. — The  medium  line  is  shown  at  M,  labial  surface  at  L,  cutting  edge 
at  C,  palatal  surface  at  P,  and  approximal  surfaces  at  A,  of  typical 
superior  central  incisors. 

the  bicuspids  and  molars  are  called  huccal,  being  next  to  the 
cheeks,  and  the  opposite  or  inner  surfaces  of  all  the  teeth,  that 
portion  presenting  toward  the  tongue,  are  called  the  lingual 
surfaces.  Some,  however,  use  the  term  "palatine  surfaces"  for 
those  of  the  upper  jaw  and  "lingual"  for  those  of  the  lower. 
While  this  is  not  necessary,  it  seems  perfectly  proper. 

Those  surfaces  of  the  teeth  that  lie  adjacent  or  next  to  the 
adjoining  teeth  are  called  proximate  or  proximal;  these  are 
more  closely  defined  or  divided  by  the  terms  mesial  and  distal. 
They  are  so  named  hj  their  relative  position  to  the  central  or 
median  line  of  the  face.  Those  proximate  surfaces  which  face 
toward  the  median  line  are  called  mesial  surfaces;  and  the  op- 
posite, or  those  most  distant  from  this  line,  are  called  the  distal 


22 


DENTAL  PATHOLOGY  AND  DENTAL  MEDICINE. 


surfaces.    These  several  surfaces  are  clearly  shown  in  Figs.  9, 
10  and  11. 


Fig,  10. — The  SevebaIj  Surfaces 
OF    A    Superior    Cuspid    Tooth. 

L  indicates  the  labial,  P,  the  pal- 
atal, and  A,  the  approximal  sur- 
faces. 


Fig.  11. — The  Three  Roots,  Neck 
AND      Crown     of     a      Superior 
Molar        Tooth,        Presenting 
Both     the     Buccal     and     Ap- 
proximal  Aspect. 
The    masticating    surface    is    indi- 
cated  at  M. 
The  cutting  edges  of  the  anterior  teeth  and  the  grinding  sur- 
faces of  the  bicuspids  and  molars  are  called  the  occluding  sur- 
faces. 


J 


^ 


Fig.  12. 


The  arrangement  of  the  teeth  in  the  dental  arch  is  repre- 
sented in  Fig.  12. 


ANATOMY  OF  THE  TEETH. 


23 


The  Normal  Articulation. — In  the  upper  jaw  the  arch  is 
larger  than  in  the  lower,  especially  in  the  anterior  portion  of 
it.  The  upper  and  lower  teeth,  therefore,  do  not  meet  perpen- 
dicularly in  articulating;  the  lower  incisors  and  cuspids  articu- 
late on  the  palatine  surfaces  of  the  corresponding  teeth  in  the 
upper  jaw.  The  cusps  of  the  lower  bicuspids  and  molars  articu- 
late in  the  grooves  and  furrows  of  the  upper,  and  the  teeth  are 
so  arranged  in  size  and  position  that  each  tooth  in  the  upper 


Fig.  13. 

jaw  when   articulating  occludes  with  two  of  the  lower  teeth. 
This  is  illustrated  in  Fig.  13. 

Primary  Dentition. 
First  dentition  takes  place,  normally,  in  the  order  given  in 
the  following  formula : — 

Central    incisors, 5th  to     7th  month. 

Lateral         "  7th  to  10th 

First    molars, 12th  to  14th 

Cuspids,  14th  to  18th 

Second    molars,         .      .      .      ,      ,      .  18th  to  25th        " 

Marked  Exceptions.— Some  children  are  born  with  a  few 
teeth  erupted,  and  there  are  cases  reported  where  the  entire 


24  DENTAL  PATHOLOGY  AND  DENTAL  MEDICINE. 

temporary  set  have  been  erupted  at  birth;  there  are  also  cases 
on  record  of  adults  who  have  been  edentulous  from  birth.  But 
these  are  rare  exceptions. 

The  force  which  causes  the  teeth  to  emerge  is  called  vital 
force,  and  operates  by  growth,  developing  first  the  neck,  then 
proceeding  gradually  to  the  apical  end  of  the  root. 

Lesions  Incident  to  First  Dentition. 

The  eruptive  process  of  dentition  is  normally  a  physiological 
action,  and  should  be  accomplished  without  serious  constitu- 
tional disturbance.  In  order  that  the  teeth  may  emerge  it  is  not 
only  necessary  that  the  overlying  gum  tissue  be  absorbed,  but 
a  portion  of  the  bony  crypt  must  be  removed  in  order  to  allow 
tlie  crown  to  pass  through.  This,  with  the  pressure  against  a 
sometimes  thick  and  swollen  gum,  and  the  backward  pressure 
upon  the  formative  organ,  does  however,  in  many  cases  cause 
serious  irritation. 

During  early  childhood  the  tissues  are  all  softer,  more  vas- 
cular and  sensitive,  the  nervous  system  predominating.  Hence 
it  is  that  the  system  at  the  period  of  first  dentition  is  so  sus- 
ceptible to  nervous  impressions.  In  infancy,  too,  the  system  is 
less  capable  of  combating  diseases,  and  a  large  portion  of  the 
alarmingly  great  mortality  of  this  period  may  be  traceable  to 
the  irritation  caused  by  dental  evolution. 

The  indications  of  the  eruption  of  the  teeth  are,  first,  an 
increased  flow  of  saliva — a  healthy  manifestation,  as  it  tends  to 
keep  the  mouth  moist  and  cool.  This  "drooling"  is  due  to  the 
irritation  of  the  trifacial  or  fifth  pair  of  nerves,  which  is  sen- 
sory to  the  teeth  and  nutrient  to  the  salivary  glands.  When  the 
irritation  becomes  more  pronounced,  the  secretions  are  some- 
what checked  and  the  month  becomes  hot  and  dry,  the  cheeks 
unusually  red,  eruptions  appear  upon  the  face,  and,  indeed, 
sometimes  over  the  whole  body;  with  ulcerations  upon  the 
tongue  and  mucous  membrane  of  the  mouth  and  inflanunation 


ANATOMY  OF   THE   TEETH. 


25 


of  the  glim  over  the  advancing  tooth  or  teeth.  A  condition  quite 
opposite  to  the  above  in  appearance  is  a  white  and  hardened 
glim  overlying  the  advancing  tooth  or  teeth.  This  offers  a 
gTeater  resistance  than  the  inflamed  condition  and  is  often  neg- 
lected, especially  by  physicians,  owing  to  the  absence  of  any 
appearance  of  congestion. 

The  child  becomes  wakeful,  peevish,  and  cross,  loses  his  appe- 
tite, and  if  relief  is  not  then  given  this  may  be  followed  by 
persistent  nausea,  diarrhoea,  and  spasms  or  con\ailsions. 

Treatment. — The  first  thing  is  to  remove  the  irritation  by 


Fig.  14. 

freely  lancing  the  gums  over  the  advancing  teeth.  The  manner 
of  doing  this  is  admirably  and  fully  shown  in  the  accompany- 
ing illustration  (Fig.  14),  which  is  taken  from  a  paper  by  the 
late  Dr.  James  W.  White,  in  the  "American  System  of  Dent- 
istry.'' If  the  convulsive  stage  is  reached,  the  patient's  feet 
should  be  placed  in  hot  mustard  water,  and  cold  cloths  applied 
to  the  head,  or  the  entire  body  put  in  a  warm  bath;  such  meas- 
ures cause  muscular  relaxation  and  have  a  soothing  effect  upon 
the  nervous  system. 


Decalcification  of  the  Temporary  Teeth. 

The  temporary  teeth  must  be  removed  before  the  per- 
manent can  erupt  in  their  normal  position;  this,  too,  is  a  physi- 


26  DENTAL  PATHOLOGY  AND  DENTAL  MEDICINE. 

ological  action  though  a  somewhat  obscure  one,  and  takes  place 
normally,  by  the  resorption  or  decalcification  of  the  roots. 

This  process  usually  commences  at  the  apex  of  the  root,  on 
the  side  nearest  to  the  successional  tooth;  this,  however,  is  not 
invariably  the  case.  Absorption  may  commence  at  several  and 
distinct  points,  sometimes  on  the  labial  side — ^that  most  distant 
from  the  succeeding  tooth. 

The  cause  and  manner  in  which  the  roots  of  the  temporary 
teeth  are  absorbed  has  been  the  subject  of  much  and  careful 
study  by  such  advanced  investigators  as  Tomes,  Peirce, 
Bodeker,  Abbot,  and  others. 

It  was  thought  for  a  long  while  that  the  pressure  caused  by 
the  advance  of  the  permanent  teeth  was  the  sole  cause  for  the 
decalcification  of  the  primary  teeth;  but  it  is  now  generally 
conceded  that  it  is  simply  the  result  of  a  physiological  action 
and  not  a  mechanical  force.  The  fact  that  the  decalcification 
of  the  deciduous  teeth  is  frequently  successfully  accomplished 
in  the  absence  of  the  corresponding  permanent  teeth  adds  much 
to  the  evidence  that  their  presence  and  pressure  is  not  essential. 

Prof.  Peirce,  in  the  "Transactions  of  the  American  Dental 
Association,"  says :  "The  several  conditions  which  are  always 
present  and  essential  are  readily  recognized,  but  the  part  each 
plays  is  not  easily  ascertained.  The  place  of  its  conmience- 
ment,  at  the  end  of  the  root,  the  retention  of.  pulp  vitality,  and 
the  presence  of  a  vascular  papilla  in  close  proximity  to  the 
absorbing  surface,  with  the  fact  that  the  surface  of  this  papilla 
is  rich  in  giant-cells,  termed  '^osteoclasts/  are  evidently  essen- 
tial accompaniments,  and  the  absence  of  any  one  of  them  would 
certainly  militate  against  the  completion  of  the  process." 

And  in  another  place  the  same  writer  says:  "That  the  organ 
has  served  its  purpose,  and  that  the  nourishment  which  had 
previously  been  appropriated  by  it  is  diverted  or  relegated  to 
its  successors,  is  probably  the  most  plausible  explanation  we 
can  give  of  this  interesting  physiological  process." 


ANATOMY   OF   THE   TEETH. 


27 


Decalcification  of  the  deciduous  teeth  commences  in 
the  central  incisors  at  about  the  fourth  year;  in  the  lateral 
incisors  in  the  fifth  year;  in  the  first  molars  the  seventh  year, 
the  second  molars  the  eighth  year,  and  the  cuspids  the  ninth 
year.  After  decalcification  commences  in  a  tooth,  it  takes  about 
three  years  for  it  to  accomplish  its  work.     (See  Fig.  15.) 


Second  Dentition. 

In  a  harmonious  development  of  the  teeth  and  jaws,  the  indi- 
cations of  the  time  approaching  for  the  development  of  the  per- 


II 

I'll 

II 

»!)■!» 


Fig.  15. — Decalcification  of  the  Deciduous  Teeth. 
(From   a  diagram  prepared  by   Prof.    C.   N.    Teirce,   1884.) 

manent  teeth  are  the  expanding  of  the  alveolar  ridge  and  the 
spreading  apart  of  the  deciduous  teeth. 

The  emergence  of  the  permanent  teeth  takes  place,  nor- 
mally, in  the  order  given  below: — 

First    molars,         6  to     7  years. 

Central  incisors, 7  to     9       " 

Lateral         "           8  to  10       " 

First    bicuspids, 10  to  11 

Second       "              11  to  12 

Cuspids 12  to  13 

Second    molars, 12  to  13 

Third          "             16  to  25 

Exceptions. — Deviations  from  the  order  of  appearance  and 
the  respective  ages  as  given  above  occur ;  it  is  usually  in  strong 


28  DENTAL  PATHOLOGY  AND  DENTAL  MEDICINE. 

cHildren  that  the  teeth  appear  at  a  later  period,  a  scrofulous 
diathesis  being  indicated  in  premature  dentition. 

Third  Dentition. 

Cases  of  third  dentition  are  reported  by  a  number  of  writers, 
but  undoubtedly  the  majority  of  these  reports  refer  to  teeth 
that  in  reality  were  part  of  the  second  set,  which  failed  to 
emerge  at  the  normal  time,  and  had  only  appeared  in  old  age 
when  there  was  sufficient  room  for  them,  or  the  jaws  had  atro- 
phied. 

The  writer  has  extracted  two  well-developed  third  molar  teeth 
(which  had  never  emerged  from  the  gums)  for  a  patient  sixty 
years  of  age;  this  was  after  the  extraction  of  the  second  molar 
roots.  It  was  known  that  the  patient  had  never  had  any  "wis- 
dom teeth." 

Anomalies  of  Number. — Supernumerary  teeth  are  espe- 
cially frequent  in  the  anterior  portion  of  the  superior  maxil- 
lary. When  sufficient  room  is  wanted  for  them,  they  may 
stand  within  or  without  the  arch.  Usually  the  shape  of  both 
the  crown  and  root  of  these  teeth  is  conical,  while  the  shape 
of  the  crown  of  those  found  in  the  posterior  part  of  the  mouth 
is  cuboidal — resembling  the  molars. 

Dentures  from  which  normal  teeth  are  missing  are  more 
frequent  than  those  containing  supernumerary  teeth.  Occa- 
sionally the  space  from  which  the  permanent  tooth  is  missing 
may  be  occupied  by  a  temporary  tooth.  Sometimes  temporary 
teeth  may  be  seen  in  the  mouth  of  persons  twenty-five  and 
thirty  years  of  age;  in  these  cases  the  permanent  ones  are  gen- 
erally retained  in  the  jaw,  and  may  erupt  later. 


INFLAMMATION.  29 

DENTAL  PATHOLOGY  AND  THERAPEUTICS. 

Dental  pathology  treats  of  the  origin  and  progress  of  the 
varous  diseases  to  which  the  teeth  and  the  surrounding  oral 
tissues  are  liable. 

Dental  therapeutics  considers  the  medicines  and  remedies 
used  in  the  treatment  of  such  diseases. 

Disease,  pathologically  considered,  is  any  abnormal  condi- 
tion in  those  processes  which  constitute  perfect  health.  It  is 
but  the  normal  physiological  force  perverted,  tearing  down 
what  it  had  before  built  up.  Its  chief  manifestations  are  ex- 
pressed by  the  word  inflammation. 

In  studying  inflammation  there  are  several  terms  which  the 
student  should  have  clearly  defined  in  order  to  have  a  proper 
appreciation  of  the  subject.  We  may  refer  to  Hyperemia,  Ple- 
thora, Anemia,  etc. 

Hyperemia  is  a  local  congestion  of  blood,  or  a  local  plethora 
of  the  capillaries. 

Plethora  then  is  an  abnormal  fulness  of  the  blood-vessels; 
generally  speaking  it  is  an  increase  in  the  entire  mass  of  blood  in 
the  system.     The  converse  of  anemia. 

Anemia  indicates  a  deficiency  in  the  volume  of  blood  in  the 
system,  but  particularly  a  deficiency  in  the  red  corpuscles.  An 
anemic  condition  therefore  indicates  an  enfeebled  condition  of 
system  as  a  whole. 

Ischemia  (is-ke'me-ah)  is  the  term  used  to  indicate  a  local 
anemia.    It  implies  a  deficiency  of  the  supply  of  blood  to  a  part. 

Inflammation. 

Inflammation  may  be  defined  as  a  disturbance  of  nutrition 
in  a  tissue  accompanied  by  heat,  redness,  swelling,  pain,  and 
impaired  function,  modified  only  by  peculiarities  of  the  struc- 
ture and  intensity  of  action.  It  is  a  series  of  changing  condi- 
tions, each  the  result  of  the  preceding  one.     It  is  essentially  a 


30  DENTAL  PATHOLOGY  AND  DENTAL  MEDICINE. 

destructive  process  and  is  the  basis  of  many  degenerative 
changes. 

The  usually  accepted  view  of  modern  pathologists  is  that 
until  the  disturbed  aria  is  invaded  by  septic  organisms  there 
can  be  no  deteriorative  action,  and  that  the  earlier  stages  there- 
fore, is  simply  a  condition  of  hyperemia.  That  is  to  say,  until 
we  have  infection  we  are  simply  confronted  with  hyperemia  or 
local  congestion. 

This  is  essentially  the  same  in  the  pulp  of  a  tooth,  as  in  the 
peridental  membrane,  mucous  membrane  or  elsewhere,  slightly 
varying  symptoms  being  induced,  as  already  indicated,  by  struc- 
tural peculiarities. 

The  first  cause  of  any  inflammatory  condition  is  irritation; 
that  is,  the  slightest  foreign  influence  disturbing  the  harmony 
of  the  functions  of  the  tissues.  This  is  most  readily  traced  in 
the  vascular  system. 

The  first  stage  may  be  accepted  as  congestion,  in  which 
the  capillary  vessels  are  excited  into  active  contraction  and  re- 
laxation, quickening  the  circulation  of  the  blood,  inducing 
warmth,  and  causing  some  discomfort. 

Acute  inflammation,  or  the  second  stage,  is  characterized 
by  warmth,  a  sense  of  fulness,  slight  swelling,  and  increasing 
pain;  the  abnormal  volume  of  blood  in  the  parts  presses  upon 
the  nerve  filaments  supplying  the  inflamed  tissue,  causing  pain 
in  accordance  with  the  expansion  of  the  vessels. 

Chronic  inflammation. — In  prolonged  inflammation,  the 
functions  of  the  parts  become  somewhat  changed,  adapting 
themselves  to  the  surrounding  conditions;  thus,  the  tissues  in- 
volved become  less  susceptible  to  the  impression  of  an  irritant, 
and  comparatively  little  pain  follows,  this  being  one  of  the 
most  noticeable  characteristics  of  chronic  disease. 

Treatment. — In  treating  inflammation,  after  removing  the 
cause,  that  is,  the  irritant,  effort  is  made  to  effect  resolution,  or 
to  hasten  suppuration. 


HYPERTROPHY.  31 

Resolution  is  the  subsidence  of  inflammation  and  a  return 
of  the  tissues  to  normality. 

Suppuration,  or  pus  formation,  being  the  breaking  down  of 
the  parts,  the  debris  of  which,  with  white  blood  corpuscles, 
forms  pus. 

The  remedies  used  are,  first,  to  remove  the  cause,  to  ad- 
minister laxatives,  and  apply  sedatives  and  stimulants. 

The  chronic  stage  of  the  inflammatory  process,  if  not 
checked,  may  result  in  one  of  several  degenerative  changes; 
among  these  are  hypertrophy,  induration,  tumefaction,  or  con- 
gestion of  the  tissues. 

Hypertrophy. 
Hypertrophy  is  an  excessive  growth  of  normal  tissue  by  the 
multiplication  of  cell  elements.     Of  the  oral  tissues,  the  gum 


Fig.  16. 

and  mucous  membrane  are  the  most  liable  to  this  disease.  The 
usual  form  recognized  is  in  a  growth  of  the  free  border  of  the 
gum,  lying  loosely  against  the  teeth,  in  some  cases  extending 
to  the  cutting  edges.  Another  form  consists  in  the  thickening 
of  the  entire  gums,  covering  the  teeth  to  such  an  extent  that 
only  the  masticating  surfaces  are  visible;  the  hypertrophied 
portion  being  firm  and  dense,  protruding  the  lip  to  such  an 
extent  as  to  cause  deformity;  this  latter  form  of  hypertrophy  of 
the  gum,  however,  is  rare. 

The  cause  of  hypertrophy  of  the  gum  tissue  is  usually  lack 
of  care  on  the  part  of  the  patient.  Calcic  matter  is  deposited 
about  the  cervical  portion  of  the  teeth,  and  this  irritates  the 
surrounding  gum  tissue  sufficiently  to  stimulate  it  to  abnormal 
activity.     The  consequence  is  a  multiplication  of  the  cell  ele- 


32  DENTAL  PATHOLOGY  AND  DENTAL  MEDICINE. 

raents  resulting  in  a  local  overgrowth  or  hypertrophy.  This 
condition  is  illustrated  in  Fig.  16. 

Treatment  consists  in  cutting  away  the  long  points  and 
borders  of  the  gum  down  to  the  necks  of  the  teeth,  and  then 
the  abnormal  growth  being  out  of  our  way,  the  treatment  obvi- 
ously is  the  careful  and  thorough  removal  of  the  irritating  de- 
posits. The  small  particles  of  calcific  matter  lying  deepest 
under  the  loosened  gums,  that  is  the  spicules  nearest  the  point 
of  actual  attachment  are  the  most  irritating.  It  is  essential, 
therefore,  that  delicately  formed  instruments  be  employed  to 
reach  the  point  of  attachment  and  dislodge  all  foreign  sub- 
stance. 

Where  the  deposits  are  very  difficult  to  dislodge,  the  work 
may  be  facilitated  by  applying  a  few  drops  of  trichloricetic  acid, 
20  per  cent.,  upon  a  small  twist  of  cotton  and  allowed  to  remain 
a  few  minutes.  Following  the  removal  of  the  calcic  matter  the 
pockets  should  be  thoroughly  irrigated  with  warm  water  and 
peroxid  of  hydrogen,  followed  by  the  application  of  stimulants 
and  astringents. 

Other  forms  of  hypertrophy  are  encountered  by  the  dentist, 
however,  and  may  be  here  referred  to.  Occasionally  we  find 
large  hypertrophied  areas  of  alveolae  process,  induced  by  irrita- 
tion in  consequence  of  lack  of  occlusion.  Another  form  is 
found  in  excementosis,  hypercementosis  or  exostosis,  as  one  may 
choose  to  term  it.  This  will  be  treated  in  another  place.  We 
also  find  hj'pertrophy  of  the  pulp  tissue,  resulting  sometimes 
from  dental  caries,  which  will  be  taken  up  under  diseases  of 
the  dental  pulp. 

Induration. 

Induration  is  a  circumscribed,  hardened  swelling;  it  is  an 
enlargement  of  individual  cells,  and  not  a  multiplication  as  in 
hypertrophy.  In  this  condition  the  functions  of  the  tissue  in- 
volved are  inactive,  the  circulation  being  very  much  retarded. 


TUMEFACTION.  33 

It  may  manifest  itself  in  the  gum,  in  the  muscles  of  mastica- 
tion, or  in  the  muscles  of  the  neck. 

Treatment. — In  induration  of  cheek  or  neck,  apply  hot 
cloths  and  an  active  stimulant,  such  as  capsicum.  When  the 
disease  is  in  the  gum,  apply  capsicum  plaster  and  lance  freely. 

Tumefaction. 

Timiefaction  is  a  condition  of  chronic  inflammation,  by 
which  is  produced  an  abnormal  amount  of  tissue,  of  a  different 
kind  from  the  surrounding  tissue,  exhibiting  a  difference  in 
color  and  texture.  Tumefaction  as  found  in  the  mouth .  is 
divided  into  epulis,  cystic,  and  vascular. 

Epulis  tumors  originate  in  the  periosteum,  and  are  usually 
found  in  the  interspaces  of  the  anterior  teeth.  They  are  fibrous 
in  structure,  and  usually  of  a  dark  red  color. 

Treatment  consits  of  excision,  care  being  taken  to  remove 
all  the  abnormal  tissue;  the  bistoury  should  be  passed  well 
around  and  under  the  tumor,  as  deep  as  the  periosteum;  after 
removing  the  growth  as  entire  as  possible  with  the  knife,  car- 
bolic acid  or  trichloracetic  acid  should  be  applied,  to  destroy 
the  vitality  of  any  fibers  that  should  remain. 

Cystic  tumors  originate  in  the  mucous  membrane;  they  are 
membraneous  in  structure,  of  a  lighter  color  than  the  normal 
mucous  membrane,  and  are  filled  with  a  viscid  fluid. 

Treatment  consists  in  lancing  at  the  lowest  points,  and 
emptying  the  contents  by  pressure,  after  which  applications  of 
stimulants  and  astringents  should  be  made. 

Vascular  tumors  arise  from  some  blood-vessel  supplying 
the  oral  tissues.  They  are  usually  of  a  dark  red  color,  and 
highly  vascular ;  they  have  a  smooth  and  shiny  surface,  and  are 
more  or  less  fibrous. 

Treatment  same  as  in  epulis  tumors. 

Congestion  is  also  often  the  result  of  inflammatory  pro- 
cesses. 


34  DENTAL  PATHOLOGY  AND  DENTAL  MEDICINE. 

The  prominent  feature  of  congestion  is  blood  stasis,  caus- 
ing severe  pain  with  each  pulsation  of  the  heart.  The  capillary 
vessels  in  the  inflamed  parts  being  engorged,  the  blood  rebounds 
at  each  pulsation  of  the  heart,  thus  causing  the  throbbing  pain. 
The  pain,  however,  is  sometimes  intermittent,  by  the  capillaries 
being  broken  through,  relieving  the  pressure  temporarily. 

Treatment  is  to  apply  stimulants  and  sedatives. 

Alveolar  Abscess. 

An  abscess  is  a  circumscribed  collection  of  pus — circum- 
scribed by  the  development  of  a  soft  membrane,  forming  a  sac. 


Fig.     17. — Result    op    an     Abscess     at     the     Root     of    an     Incisob 
Tooth  ;  a  indicates  abscess  cavity  ;  b,  mouth  of  fistula  on  gum 

ABOVE   LABIAL    SURFACE    OF   THE   TOOTH  ;    C,    MOUTH   OF   FISTULA   OPENING 
ON    THE    PALATAL    SURFACE, 

restraining  the  pus  from  passing  into  the  surrounding  tissues, 
causing  it  to  seek  the  surface  at  the  point  of  the  least  resist- 
ance. The  pus  works  its  way  through  the  tissue  at  this  point, 
forming  an  escape  called  a  fistula. 

An  alveolar  abscess  is,  as  the  name  indicates,  an  abscess 
originating  within  the  alveolar  walls.  It  is  the  result  of  inflam- 
mation of  the  pericemental  membrane,  consequent,  usually, 
upon  the  death  and  septic  decomposition  of  the  tooth  pulp. 

Symptoms  of  alveolar  abscess  are  congestion  and  inflam- 
mation of  the  gums  about  the  affected  tooth;  severe  pain  which 
is   often    accompanied   by   considerable   fever.      There   is    also 


ALVEOLAR   ABSCESS.  35 

apparent  elongation  of  the  tooth,  caused  by  inflammation  of 
the  pericemental  membrane  and  accumulation  of  pus  in  its 
socket;  the  pus  formed,  being  confined  about  the  apical  end  of 
the  root,  and  between  bony  walls,  causes  considerable  pressure 
as  it  accumulates.  The  bone  in  this  neighborhood  is  not  of  a 
very  hard  nature,  and  in  consequence  is  readily  destroyed  by  the 
pus  in  its  efforts  to  seek  the  surface.  During  the  time  the  pus 
is  penetrating  the  bone  the  patient  suffers  most ;  the  pain  at  this 
stage  being  very  severe  and  of  a  throbbing  character. 

The  features  become  swollen  and  disfigured  on  the  affected 
side;  the  eye  is  sometimes  entirely  closed,  and  the  jaws  so  stiff 
that  the  mouth  can  not  be  opened  to  any  considerable  distance. 

Treatment. — The  surgical  and  local  treatment  consists  in 
gaining  free  access  to  the  diseased  parts,  and  removing  the 
cause,  and  breaking  up  the  sac  of  the  abscess.  In  securing 
ready  access  to  the  point  of  accumulation  it  is  best  to  first  open 
up  the  canals  of  the  affected  tooth.  In  doing  this  it  is  better 
to  sacrifice  good  tooth  structure  than  to  attempt  to  work  around 
corners  and  through  too  small  a  canal,  being  careful  to  follow 
the  line  of  the  canal,  and  not  perforate  the  side  of  the  root; 
after  which  the  canal  should  be  thoroughly  irrigated  with  per- 
oxide of  hydrogen  followed  by  a  dressing  of  an  effective  anti- 
septic and  germicide  before  filling. 

Where  the  abscess  has  advanced  to  any  considerable  extent, 
it  will  sometimes  be  found  necessary  to  more  freely  open  or 
enlarge  the  fistulous  canal  by  driling  in  through  the  gum  and 
alveolar  process  over  the  affected  tooth  with  a  medium-sized 
rose-head  burr  revolved  by  the  dental  engine.  In  so  doing  the 
parts  may  be  more  thoroughly  drained  and  treated,  and  the  sac, 
when  attached  to  the  end  of  the  root,  can  be  more  readily 
reached  and  broken  up. 

If  the  patient  is  in  an  otherwise  healthy  condition,  nature 
will  finish  the  work  by  throwing  off  the  broken-down  tissue  and 
developing  new   granulations,   without   further   treatment.     It 


36  DENTAL  PATHOLOGY  AND  DENTAL  MEDICINE. 

would  be  advisable,  however,  to  assist  in  throwing  off  the  foreign 
matter  by  injecting  peroxide  of  hydrogen  and  warm  water  freely 
into  the  enlarged  fistulous  opening  and  socket. 

Where  the  patient  is  of  low  vitality,  or  the  abscess  of  long 
standing,  other  therapeutic  treatraent  must  follow  the  surgical 
before  a  cure  can  be  accomplished.  After  cleansing  the  canals 
thoroughly  with  peroxide  of  hydrogen,  as  before  stated,  some 
one  of  the  more  efficient  antiseptic  and  disinfectant  remedies, 
such  as  carbolic  acid  and  iodine,  or  oil  of  cinnamon,  should 
be  applied  on  a  strand  of  floss  silk,  or  a  few  fibers  of  cotton,  or 
asbestos,  which  should  be  carried  to  the  apex  of  the  root  by 
means  of  a  nerve  canal-plugger,  and  the  crown  cavity  closed 
with  a  temporary  stopping.  The  gum  tissue  about  the  affected 
tooth  should  then  be  painted  with  tincture  of  iodine  and  aconite, 
which  will  aid  in  the  reduction  of  the  inflammation  by  counter- 
irritation.  This  treatment  should  be  repeated  in  from  two  to 
three  days,  and  continued  according  to  the  character  and  symp- 
toms of  the  case  in  hand. 

Other  causes  than  that  of  the  death  and  decomposition  of 
the  pulp  may  give  rise  to  alveolar  abscess;  any  foreign  ma,tter, 
such  as  filling  material,  being  forced  through  the  apex  of  the 
root,  calcic  deposits  within  the  walls  of  the  alveolus,  necrosed 
root  or  hone,  impacted  teeth,  etc.,  may  cause  sufficient  inflam- 
mation of  the  periosteum  to  produce  an  abscess,  all  the  suc- 
cessive stages  of  inflammation  being  involved  in  the  formation 
of  an  abscess,  from  irritation  to  suppuration.  This  is  quite  as 
true  in  connection  with  vital  teeth  when  calcic  deposits  are 
made  upon  the  pericemental  membrane  in  sufficient  quantity 
to  cause  inflammation  of  that  structure. 

Ulceration. 
The  terms  ulcer  and  abscess   are  frequently  confounded  by 
students,   and   a  general  comparison  may  therefore  be   advan- 
tageous. 


STOMATITIS.  37 

An  nicer  forms  upon  the  surface,  that  is,  has  its  inception  on 
a  cutaneous  surface.  An  abscess  forms  in  some  cavity  within 
the  body.  An  ulcer  is  never  induced  by  pyogenic  bacteria, 
while  infection  from  these  organisms  is  the  primary  cause  of 
an  abscess. 

An  ulcer  is  an  open  suppurating  surface;  an  abscess  is  m 
circumscribed  collection  of  pus. 

An  ulcer  usually  has  its  inception  in  some  morbid  structural 
change  or  old  wound;  an  abscess  is  the  result  of  some  recent 
degenerative  condition. 

Treatment  for  ulceration  consists  in  applying  astringents 
and  antiseptics,  and  administering  a  tonic. 

Stomatitis. 

The  term  stomatitis  implies  an  inflammatory  condition  of  the 
tissues  of  the  mouth.  It  is  sometimes  employed  to  cover  diverse 
conditions,  though  its  usual  application  is  to  the  tongue  and 
mucous  membrane.  It  is  usually  due  to  a  lack  of  oral  hygiene. 
and  is  more  frequent  in  the  mouths  of  infants,  especially  among 
the  children  of  the  very  poor  where  nourishing  foods  and  sani- 
tary surroundings  are  not  much  in  evidence. 

It  may  be  said  then  to  be  due  to  improper  food,  infected  milk 
from  lack  of  care  in  cleansing  and  scalding  the  nursing  bottle, 
irritating  fungi  harbored  by  rubber  nipples,  and  from  other 
unsanitary  conditions. 

In  adults  a  general  neglect  of  the  teeth  and  mouth  may  re- 
sult in  stomatitis.  If  food  particles  and  mucous  accumulations 
are  allowed  to  remain  between  the  teeth  and  about  the  free 
margins  of  the  giims  indefinitely  the  fermentation  and  putre- 
faction resulting  will  cause  gingivitis,  which  by  continuity  of 
structure  will  spread  over  the  entire  mouth.  Anemic  persons 
are  specially  liable  to  inflammatory  conditions  of  the  mucous 
membrane,  and  where  it  continues  for  a  considerable  length  of 
time  may  result  in  an  ulcerative  stomatitis. 


38  DENTAL   PATHOLOGY  AND  DENTAL  MEDICINE. 

L#ocal  inflammation  of  the  gums,  which  can  not  be  classed 
as  general  stomatitis — though  it  would  contribute  to  a  general 
inflammatory  condition  of  the  mucous  membrane  of  the  mouth 
where  other  unsanitary  conditions  are  present — may  result  in 
a  loosening  and  thickening  of  the  gingivae,  a  form  of  pyorrhea, 
or  a  serious  hypertrophy  of  the  gums.  These  several  conditions 
will  be  treated  under  their  proper  classification. 


DISEASES  OF  THE  DENTAL  PULP  AND 
MEMBEANE. 

Inflammation  of  the  Pulp  or  Pulpitis. 

As  in  other  tissues,  inflammation  is  induced  in  tfie  pulp  by 
irritation,  and  is  similar  to  inflammatory  conditions  in  other 
tissues  except  slight  modifications  owing  to  the  surrounding 
conditions.  The  most  raarked  of  these  conditions  is  the  fact 
that  the  pulp  is  enclosed  within  close  and  unyielding  walls.  In 
addition  to  this  the  blood-vessels  of  the  pulp  are  modified  in 
structure  in  that  they  lack  the  muscular  coats  of  other  blood- 
vessels; while  the  nerves  of  the  pulp  lack  the  general  structure 
of  those  of  the  general  nervous  system  and  have  not  the  usual 
sheaths. 

The  most  frequent  cause  is  the  encroachment  of  dental  caries ; 
this  removes  the  normal  covering  of  the  pulp,  allowing  thermal, 
chemical  and  mechanical  irritation  to  readily  reach  that  soft 
and  sensitive  tissue. 

Treatment. — If  irritation  has  been  mild  and  only  for  a  few 
days,  immediate  filling  will  give  relief.  By  mild  we  mean  re- 
sponsiveness to  thermal  changes,  but  passing  away  where  the 
irritation  is  removed;  paroxysmal  and  returning  only  upon 
provocation.  If  the  irritation  had  continued  for  several  days, 
and  has  been  severe  enough  to  cause  actual  pain,  which  condi- 
tion may  be  designated  as  hyperemia  of  the  pulp,   treatment 


DISEASES   OF   THE  DENTAL   PULP  AND  MEMBRANE.  39 

consists  in  applying  some  stimulating  antiseptic  and  filling  with 
a  good  temporary  stopping.  If  no  further  pain  is  felt  within 
ten  days,  fill  permanently.  When  the  irritation  has  continued 
for  a  considerable  length  of  time,  the  pulp  being  seriously  in- 
volved though  it  may  not  be  exposed,  or  in  cases  where  the  pulp 
is  exposed  from  the  disintegration  of  the  dentine  covering,  we 
have  a  very  different  condition  to  cope  with.  Instead  of  having 
the  quick,  sharp  flashes  of  pain,  disappearing  in  a  short  time, 
the  pain  becomes  almost  continuous,  accompanied  with  a  bor- 
ing sensation,  indicating  tl.at  the  inflammation  had  passed  to 
effusion,  in  which  there  is  an  extravasation  or  working  out  of 
the  blood  into  the  body  of  the  pulp.  Up  to  this  time  there  is 
strong  probability  of  the  pulp  returning  to  its  normal  condition 
if  treated  as  indicated,  but  this  point  having  been  reached  the 
probabilities  are  against  its  conservation,  and  it  is  generally 
preferred  to  devitalize  and  extirpate  the  pulp  and  fill  the  canals 
before  attempting  to  fill  the  crown  cavity. 

In  teeth  that  are  not  carious,  inflammation  of  the  pulp 
may  arise  from  violent  thermal  changes,  to  which  they  are  some- 
times very  sensative,  and  if  repeatedly  exposed  to  such  changes 
death  of  the  entire  pulp  may  be  the  result.  Or  some  slight 
mechanical  injury,  resulting  from  a  fall  or  blow,  may  cause 
sufficient  congestion  to  cause  death  of  the  pulp.  Hence,  we  not 
infrequently  find  teeth  with  devitalized  pulps  that  are  other- 
wise sound. 

Treatment  in  such  cases  is  very  simple.  If  the  irritation 
is  from  thermal  changes  and  has  not  been  of  long  standing,  the 
pulp  will  return  to  its  normal  condition  by  simply  removing  the 
irritant;  that  is,  protecting  the  teeth  from  such  marked  ther- 
mal changes  and  applying  a  good  stimulant,  such  as  tincture  of 
iodine,  to  the  gum  over  the  root  of  the  tooth  affected.  If  the 
pulp  has  been  devitalized  or  the  irritation  has  continued  for 
such  a  length  of  time  as  to  make  devitalization  necessary, — that 
is,  where  it  will  not  respond  to  the  treatment  just  described, — it 


40  DENTAL   PATHOLOGY  AND  DENTAL  MEDICESTE. 

should  be  removed  by  opening  the  tooth  at  a  point  making  the 
pnlp  chamber  and  canal  of  most  easy  access;  and  after  the  de- 
vitalized organ  is  removed  the  canals  should  be  thoroughly  filled. 

Inflammation  of  Pulp  Following  Filling. — Occasionally 
inflammation  of  the  pulp  follows  the  filling  of  carious  teeth. 
This  may  arise  from  mechanical  irritation,  that  is,  undue  pres- 
sure upon  the  pulp  by  the  capping  or  filling  material;  chemical, 
by  the  action  of  acids  used  in  the  capping  or  filling  material ;  or 
thermal,  by  the  conductibility  of  the  filling  material,  readily 
carrying  every  impression  to  the  pulp. 

Treatment. — This  can  be  readily  diagnosed,  and  when  the 
inflammation  is  only  superflcial  the  pulp  may  be  restored  to 
health  by  removing  the  irritant  and  treating  as  directed  above. 
But  when  inflammation  is  more  general  (and  every  precaution 
has  been  taken  in  filling  the  tooth),  a  general  engorgement  of 
the  blood-vessels  and  possibly  effusion  is  indicated,  there  is  no 
reasonable  probability  that  it  can  be  saved;  the  filling,  there- 
fore, should  be  taken  out,  the  pulp  destroyed  and  removed,  the 
canals  thoroughly  closed  and  the  tooth  refilled. 

Hypertrophy  of  the  pulp  is  preceded  by  chronic  inflam.- 
mation,  and  is  indirectly  the  result  of  caries.  In  hypertrophy  of 
this  organ  the  nerves  do  not  retain  the  same  degree  of  growth  as 
the  connective  tissue ;  the  pulp  polypus  is,  therefore,  not  so  pain- 
ful as  the  normal  or  acutely  inflamed  portion;  for  this  reason 
such  growths  are  permitted  to  remain  in  the  cavity  for  months 
before  the  patient  calls  for  treatment. 

Treatment  consists  in  the  extirpation  of  the  polypus,  then 
the  devitalization  and  removal  of  the  remainder  of  the  pulp, 
before  filling. 

Secondary  Dentine. 

There  are  several  manifestations  of  secondary  dentine,  which 
are  classed  as: — 

(i)  Dentine  of  repair,  a  physiologic  process,  wherein  na- 
ture through  the  odontoblasts  interposes  a  secondary  deposition 


DISEASES   OF   THE   DENTAL   PULP  AND  MEMBRANE.  41 

of  calcic  matter.  This  is  physiologic  inasmuch  as  it  is  an  at- 
tempt to  repair  a  loss  of  covering  through  caries,  or  to  protect 
the  pulp  from  the  encroachment  of  erosion  or  abrasion. 

(2)  Osteodentine  or  calcic  degeneration  of  the  pulp.  This 
is  where  the  process  last  referred  to — the  deposit  upon  the 
periphery  of  the  pulp  usually  for  self -protection, — is  continued 
until  the  entire  body  of  this  organ  is  calcified.  This  secondary 
dentine  differs  somewhat  from  the  primary  dentine;  it  has  fewer 
tubules,  and  is  calcified  from  several  centers  which  are  finally 
fused  together,  making  it  quite  irregular  in  form. 

(3)  Nodular  Dentine,  erratic  growths  or  calcic  exudations 
into  the  pulp  tissue.  In  other  words  it  is  a  formation  of  small 
nodules  of  calcified  matter  within  the  pulp  cavity;  they  are  gen- 
erally confined  to  the  body  of  the  pulp,  but  at  times  nodules  are 
found  within  the  root  canals.  Since  nodular  calcifications 
sometimes  occur  in  the  pulps  of  teeth  the  crowns  of  which  are 
perfect,  there  being  neither  abrasion  nor  decay,  though  decay 
may  be  and  often  is,  found  in  connection  with  such  formations, 
the  presence  of  these  bodies  is  evidently  due  to  some  other  cause 
that  is  as  yet  unknown.  These  bodies  give  much  trouble  when 
connected  with  other  diseases  affecting  the  tooth  pulp,  and 
sometimes  give  serious  trouble  in  themselves.  This  form  of 
secondary  dentine  should  therefore  be  classed  as  pathologic. 
When  the  bodies  do  occasion  trouble,  it  is  generally  in  the 
form  of  infra-orbital  neuralgia,  with  paroxysms  of  pain  in  one 
or  more  of  certain  teeth.  Patients  with  these  symptoms  some- 
times present  themselves.     In  "these  instances,  where  no  carous 

0 

or  otherwise  visibly  diseased  teeth  are  found,  it  may  be  pre- 
sumed that  the  pain  is  caused  by  an  odontinoid  formation  in 
the  pulp  of  one  of  these  teeth.  To  ascertain  the  affected  tooth, 
the  usual  tests  of  cold  water  and  percussion  should  be  em- 
ployed, when  the  patient  will  usually  express  some  abnormal 
feeling  in  the  tooth  or  teeth  containing  these  formations. 

Treatment.— When   pulp    stones    are    diagnosed,    the   tooth 


42  DENTAL   PATHOLOGY  AND  DENTAL  MEDICINE. 

should  be  drilled  into,  in  the  best  position  and  direction  for 
reaching  the  pulp;  this  done,  arsenious  acid  should  be  applied 
for  the  devitalization  of  the  pulp,  which,  of  course,  should  be 
thoroughly  removed  and  the  root  canals  and  tooth  filled. 

Gangrene  of  the  pulp  (death  in  a  body  without  loss  of 
substance,  as  in  suppuration). — Gangrene  of  the  pulp  not  infre- 
quently is  the  result  of  acute  inflammation;  the  over-supply  of 
blood  in  the  arteries  compresses  the  veins  at  the  dental  foramen, 
interrupting  the  circulation  so  as  to  cut  off  all  nutrition  from 
this  territory,  causing  death  to  the  pulp  in  a  hody.  Gangrene 
occurs  in  two  forms,  dry  and  moist.  Dry  gangrene  is  where 
the  pulp  becomes  a  dry  and  shriveled  mass,  or  mummified. 
Moist  gangrene  is  where,  after  death  en  masse,  we  have  putre- 
factive decomposition  of  the  pulp.  Treatment  consists  in  the 
removal  of  all  remnants  of  pulp  and  in  perfect  disinfection  of 
the  root  canals  before  filling. 

Pericementitis. 

Pericementitis  (inflammation  of  the  pericemental  niem- 
brane)  may  arise  from  some  one  or  more  of  the  following  irri- 
tants: inflammation  of  the  pulp,  putrescent  pulp,  excess  of  fill- 
ing material,  looseness  of  the  tooth  or  root,  salivary  or  sanguin- 
ary calculus,  dental  manipulation,  mal-occlusion,  want  of  occlu- 
sion, mercurial  poisons,  previous  pericementitis,  etc. 

The  pericementum  serves  as  a  cushion,  breaking  the  force 
directed  upon  the  tooth  in  masticating  or  other  external  vio- 
lence, hence  we  find  it  subject  to  occasional  irritation  from  this 
source.  This  tissue,  too,  is  very  vascular  and  not  infrequently 
is  it  infected  from  a  decomposing  pulp ;  this  is  in  fact  the  most 
fruitful  source  of  pericementitis. 

Symptoms. — There  is  sometimes  confusion  as  to  the 
symptoms  which  distinguish  pulpitis  from  pericementitis. 
Therefore,  that  the  student  may  have  a  clear  conception  of  the 
differentiating  symptoms  they  are  compared  in  detail : 


DISEASES  OF  THE  DENTAL  PULP  AND  MEMBRANE.  43 

PERICEMENTITIS.  PULPITIS. 

A  kuowledge  of  the  presence  of  the  Sometimes  difficult  at  first  to  de- 
tooth,  there  being  no  trouble  to  locate  termine  just  which  tooth  is  at  fault, 
the  one  affected.  the  paiu  being   more  or  less  fleeting. 

There     is     apparent     elongation,     the  ^,           .               i          ^- 

effected  to.,th   being   the  first   to   strike  There    is    no    elongation,     nor    incon- 

iu   closing   the  mouth.  vemence  in  closing  the  teeth. 

There    is    pain    following    the    slight-  There   is   no   pain   upon   tapping,    and 

est     pressure     from     occlusion    of    the  tootle    can    be    used    in    masticating    if 

jaws,    or    from    the    tongue    or   finders.  thermal   extremes   are    avoided, 

or  from   tapping  the   tooth.  The    pain    is    sharp,    and    darting    in 

The  pain  is  dull  and  constant,  not  character,  and  in  earlier  stages  par- 
paroxysmal  in   character.  oxysmal. 

There  is   no  material   sensation   from  Tooth      is      extremely      sensitive      to 

thermal  changes.  thermal   extremes. 

Treatment. — First  remove  the  irritants,  vital  or  mechanical, 
then  apply  a  good  stimulant  and  sedative  to  the  gnni  over  the 
affected  tooth,  to  hasten  resolution.  A  hot  foot-bath  is  also 
beneficial  in  relieving  the  blood  pressure  in  the  diseased  parts. 
When  gangrenous  or  putrescent  pulp  is  diagnosed,  the  teeth 
should  be  thoroughly  opened  up,  every  vestige  of  the  pulp  re- 
moved, the  canal  roots  thoroughly  cleansed  and  disinfected  as 
soon  as  the  soreness  will  permit. 

Pyorrhoea  Alyeolaris. 

Pyorrhoea  alveolaris  is  a  term  applied  to  a  condition  char- 
acterized by  a  breaking-down  of  the  alveolar  walls;  forma- 
tion of  pus  about  the  roots  of  the  teeth;  a  deposit  of  calculi, 
either  salivary,  sanguinary,  or  both,  upon  the  teeth;  a  destruc- 
tion of  the  pericementum,  inflammation  of  the  surrounding 
tissues,  and  accompanied  by  a  general  calcic  diathesis.  This 
condition  has  been  known  by  numerous  names;  for  many  years 
it  was  called  "Rigg^'s  Disease,"  expressing  nothing.  It  was  so 
called  because  Dr.  J.  M.  Riggs,  of  Hartford,  Connecticut, 
was  first  to  give  it  much  concern  and  to  call  public  attention  to 
it  as  a  distinct  pathologic  condition. 

Pyrrhoea  alveolaris  has  been  divided  by  Professor  Peirce  into 
two  classes :  (1)  Those  of  local  origin,  and  (2)  those  having 
their  origin  in  a  constitutional  derangement.  In  writing  upon 
this  subject*  Dr.  Peirce  stated  that  in  the  effort  to  reduce  the 

*For  the  Odontological   Society  of  New  York,  November,   1893. 


44  DENTAL   PATHOLOGY  AjSJD  DENTAL  MEDICINE. 

disease  to  tlie  simplest  factors  and  determine  the  primary  ori- 
gin of  each,  he  should  coin  two  terms,  expressive  as  to  the  na- 
ture of  the  disease. 

The  first  form,  where  the  salt  is  deposited  from  the  saliva, 
he  has  designated  as  ptyalogenic  calcic  pericementitis,  express- 
ing the  idea  that  in  its  origin  it  is  local,  peripheral,  and 
salivary.  This  is  characterized  by  a  loosening  and  driving  back 
of  the  gum  tissue,  by  the  accumulation  of  calcic  deposits;  the 
gums  becoming  turgid  and  inflamed.  A  viscid,  degenerate 
mucous  may  be  forced  from  beneath  the  loosened  gum,  and  it 
may  be  found,  in  more  advanced  cases,  that  the  irritation  has 
reached  and  involved  the  alveolar  process  and  pericemental 
membrane.  When  this  condition  is  reached  it  is  usually  fol- 
lowed by  a  more  or  less  discharge  of  pus  and  loosening  of  the 
teeth.  This  form  of  pyorrhoea  alveolaris  may,  therefore,  be  at- 
tributed to  a  general  lack  of  oral  hygiene.  The  irritation  in 
some  instances  is  contributed  to  by  mal-occlusion  or  non-occlu- 
sion of  aifected  teeth. 

The  second  is  designated  as  hematogenic  pericementitis,  ex- 
pressive of  the  idea  that  in  its  origin  it  is  constitutional,  cen- 
tral, and  associated  with  some  modification  of  the  normal  com- 
position of  the  blood  plasma.  This  is  the  condition  which  may 
be  termed  true  pyorrhoea  alveolaris.  This  latter  form  of  the 
disease  has  been  demonstrated  by  Professor  Peirce  to  usually 
accompany  the  gouty  diathesis,  and  he  has  been  misquoted  by 
many  in  that  it  was  the  result  of  gout.  His  researches,  however, 
show  that  it  is  not  the  result  of  this  disease,  as  it  may  exist 
where  there  are  no  marked  symptoms  of  gout,  but  that  the  pre- 
disposing cause,  uric  acid,  or  other  waste  products,  are  aniver- 
sally  present.  In  other  words  it  is  another  expression  of  the 
uric  acid  condition. 

One  of  the  conditions  usually  present  in  this  form  of  the 
disease,  is  the  accumulations  of  sanguinary  calculi,  very  hard 
and  dark  colored  nodules  upon  the  roots  of  the  teeth  affected. 


DISEASES   OF   THE  DENTAL   PULP  AND  MEMBRANE.  45 

which  concretions  have  repeatedly  been  found  to  contain  uremic 
salts,  indicating  a  constitutional  derangement. 

Clinical  History. — The  clinical  history  of  pyorrhoea  alveo- 
laris  is,  as  has  been  previously  indicated,  a  deposition  of  calcic 
matter  upon  the  necks  or  roots  of  the  teeth;  a  loosening,  swell- 
ing, and  more  or  less  inflammatory  condition  of  the  gums;  an 
oozing  of  pus  from  beneath  the  gum  margins;  a  resorption  of 
the  alveolar  borders;  and  a  progressive  loosening  and  mal- 
position of  the  affected  teeth.  The  true  form  of  pyorrhoea  alveo- 
laris  being  coincident  with  some  of  the  familiar  expressions  of 
the  uric  acid  diathesis,  such  as  rheumatism  and  gout. 

Treatment. — In  this,  as  in  all  diseased  conditions,  the  first 
effort  should  be  to  remove  the  cause — that  is,  the  source  of  irri- 
tation. Where  the  exciting  cause  is  purely  local,  that  is,  where 
lack  of  cleanliness  and  the  irritation  from  foreign  substances 
impinging  on  the  gingival  margin  establishes  a  local  gingivitis, 
the  treatment  is  of  a  simple  nature.  It  may  be  simply  the  re- 
moval, by  suitable  scaling  instruments,  of  all  calculary  deposits 
from  the  necks  and  roots  of  the  teeth,  a  very  simple  line  of 
surgical  procedure  and  should  be  most  thoroughly  and  care- 
fully carried  out.  This  should  be  followed  with  local  astrin- 
gent and  stimulating  treatment  for  the  gums,  and  enforced 
hygienic  treatment  of  the  mouth.  If  mal-occlusion  or  lack  of 
occlusion  play  any  part,  this,  too,  should  be  corrected,  if  need 
be,  by  the  insertion  of  a  sufficient  number  of  artificial  teeth  to 
overcome  the  difficulty ;  or,  if  any  of  the  teeth  become  very  loose, 
as  we  more  frequently  find  the  lower  incisors,  they  should  be 
securely  bound  together  by  some  light  mechanical  appliance. 

When  the  origin  is  in  a  systemic  derangement  which 
is  usually  found  to  be  a  uric  acid  diathesis,  the  general  treat- 
ment is  directed  toward  the  elimination  of  waste  products;  a 
plain,  wholesome  diet  and  open-air  exercise  should  be  pre- 
scribed. In  such  cases  the  medicinal  treatment  should,  as  has 
been  indicated,  be  directed  toward  the  elimination  of  uric  acid 


46  DENTAL  PATHOLOGY  AND  DENTAL  MEDICINE. 

and  its  compounds.  For  this  purpose  some  of  the  various  lith- 
ium preparations  are  indicated.  And  the  free  use  of  alkaline 
waters — Vichy,  Carlsbad,  Apollinaris,  etc. 

In  these  cases  we  find  deep  pockets  about  the  affected  teeth, 
formed  by  the  breaking  down  of  the  surrounding  alveolar  wall; 
the  pockets  contain  pus  to  a  greater  or  less  extent,  a  quantity  of 
which  can  be  forced  out  by  a  gentle  manipulation  of  the  gums. 
There  is  accompanying  this  condition  a  heavy,  metallic-like 
odor  to  the  breath,  which  is  increased  or  diminished  with  the 
quantity  of  pus  present. 

By  a  careful  exploration  of  these. pockets  we  will  detect  well 
up  toward  the  apex  of  the  root,  and  closely  attached  to  its  side, 
hard  and  gritty  nodules — the  sanguinary  deposits  previously 
referred  to. 

In  addition  then  to  the  above  anti-gout  regime,  careful  local 
treatment  should  be  given  these  roots  and  pockets.  The  roots 
should  be  cleansed  as  thoroughly  as  possible  from  all  calcic 
deposits,  the  pockets  formed  about  the  roots  should  be  freely 
irrigated  with  peroxide  of  hydrogen  in  warm  water,  followed  by 
the  introduction  of  a  few  drops  of  pyrozone,  25  per  cent.,  or  tri- 
chloracetic acid,  50  per  cent.,  or  lactic  acid,  or  zinc  chloride,  as 
some  operators  prefer,  in  each  pocket.  These  drugs  are  best 
applied  upon  a  thin,  wedge-shaped  piece  of  orange  wood,  or  upon 
a  small  twist  of  cotton  which  may  be  forced  to  the  extremities 
of  the  pocket,  and  allowed  to  remain  for  a  few  minutes,  when 
the  cotton  should  be  withdrawn.  This  will  "burn  out"  the 
pockets,  stimulating  the  formation  of  new  granulations;  then 
the  application  of  local  stimulants,  such  aF  the  tincture  of 
iodine,  should  be  made  to  the  surface  of  the  gums,  and  repeated 
at  frequent  intervals. 

Dental  Erosion. 
Dental  erosion  is  a  chemical  solution  of  the  faces  of  teeth, 
and  should  not  be  confounded  with  dental  caries  or  mechanical 


DISEASES   OF  TliE   DENTAL   PULP  AND  MEl^IBRANK,  47 

abrasion.  The  labial  surfaces  of  the  teeth  are  usually  attacked, 
resulting  in  the  formation  of  cup-shaped  excavations.  The  ero- 
sion, in  some  cases,  progresses  until  the  pulp  area  is  encroached 
upon;  in  these  cases,  however,  it  is  usually  found  that  nature 
has  caused  a  deposit  of  calcic  matter  to  be  made  at  the  per- 
iphery of  this  organ  in  advance  of  the  progress  of  the  erosion, 
so  that  when  the  pulp  is  reached  it  is  found  to  be  entirely  ob- 
literated through  calcification. 

Cause. — Dental  erosion  is  the  result  of  the  action  of  acid 
secretions  from  the  labial  glands,  caused,  probably,  by  the  pa- 
tient being  of  the  uric  acid  diathesis. 


Fig.    18. — A    TypiCAii    Case    of    Erosion,    showing    the    cup-shaped 

CAVITIES   on  the  FACE  OF  EACH   OF  THE  ANTERIOE  TEETH. 

Treatment. — ^When  the  solution  has  proceeded  to  any  depth, 
the  cavities  may  be  filled.  At  the  same  time  an  alkaline  mouth- 
wash should  be  persistently  used  to  counteract  the  acidity  of  the 
oral  secretions;  counter-irritants  may  be  applied  to  the  tissues 
surrounding  the  glands,  and  in  extreme  cises  the  destruction  of 
the  glands  by  the  electric  needle  has  been  suggested  by  Profes- 
sor Brubaker. 

Exostosis. 
Exostosis,  or  hypercementosis,  is  a  disease  common  to  all 
bones,  but  owing  to  the  vascularity  of  the  cementum  of  the 
tooth,  it  is  of tener  found  there  to  a  greaater  or  less  degree  than 
in  any  other  part  of  the  osseous  structure.  It  consists  of  out- 
growth of  new  tissue  from  the  cemental  layer  covering  the 
roots  of  the  teeth.  It  sometimes  takes  the  form  of  prominent 
nodules,  and  again  will  be  found  in  regular  layers  or  masses 
covering  a  large  portion  of  the  cementum. 


48 


DENTAL  PATHOLOGY   AND   DENTAL   MEDICINE. 


The  specimens  of  hypercementosis  shown  in  Fig.  19  are  from 
the  practice  of  Dr.  William  Jarvie,  and  are  teeth  successively 
lost  by  one  patient. 

The  cause  of  exostosis  is  inflammation  of  the  pericemental 
membrane  (pericementitis),  which  may  be  induced  by  mal- 
occlusion, want  of  occlusion,  shock  from  severe  dental  opera- 
tions, or  other  violence,  such  as  biting  thread — a  habit  formed 
by  many  seamstresses.  Where  any  of  the  above  conditions  are 
continued  for  any  length  of  time  it  causes  an  abnormal  energy 
in  the  odontoblastic  layer  of  the  cementum,  producing  increase 


Fig.  19. 

in  the  growth  of  the  structure.  The  alveolus  is  in  many  cases 
enlarged  or  absorbed  in  proportion  to  the  growth  of  cementum, 
and  the  patient  experiences  little  or  no  inconvenience,  but  there 
are  often  instances  where  the  enlargement  of  the  cementum 
causes  such  pressure  on  nerve  filaments  as  to  give  more  or  less 
discomfort,  and  sometimes  excruciating  pain;  at  times,  too,  it 
causes  severe  facial  neuralgia  quite  remote  from  the  seat  of  the 
trouble.  It  also  happens  in  rare  cases  that  the  roots  of  adja- 
cent teeth  in  this  way  become  firmly  united. 

Treatment. — ^Where  it  is  possible  to  discover  this  disease  at 
an  early  stage,  the  frequent  application  of  a  good  counter-irri- 
tant, such  as  tincture  of  iodine,  over  the  affected  root  may  in- 
terfere with  its  progress.    But  where  the  disease  has  established 


DISEASES    OF    THE    HARD   DENTAL    STRUCTURE. 


49 


itself,  the  extraction'  of  the  affected  tooth  or  teeth  is  the  only 
available  treatment. 


DISEASES  OF  THE  HAED  DENTAL  STRUCTURE. 

Dental  Caries. 
Dental  caries  is  the  gradual  softening  and  molecular  disin- 
tegration of  the  tooth  substance,  proceeding  from  the  periphery 
toward  the  pulp.     It  first  appears  as  a  chalky,  opaque  spot  in 


Fig.  20.- 


-PENETEATION    OF    THE    TUBULI    BY    MiCRO-OKGANISMS. 

(Barrett  after  Mummery.) 


the  enamel  in  which  the  structure  is  loosened  and  gradually 
broken  down. 

In  studying  the  causes  of  any  disease  they  are  divided  into 
two  general  groups,  predisposing  and  exciting.  By  "predispos- 
ing" we  mean  such  causes  as  render  the  system  or  organ  liable 
to  attack,  yet  in  themselves  are  not  sufficient  to  cause  the  dis- 
ease. By  "exciting"  we  mean  such  causes  as  are  actually  re- 
sponsible for  the  establishment  of  the  disease.  The  etiology 
of  dental  caries  will,  therefore,  be  considered  both  from  the  pre- 
disposing and  exciting  standpoint. 


)0 


DENTAL  PATHOLOGY   AND  DENTAL  MEDICINE. 


The  exciting  cause  of  dental  caries  is  (1)  the  action  of 
lactic  acid,  resulting  from  fermentation  of  food  debris,  which 
attacks  and  breaks  down  the  inorganic  substance.  (2)  The 
destruction  of  the  organic  matrix  through  the  solvent  action 
of  certain  forms  of  micro-organisms.  That  is,  after  the  enamel 
rods  have  been  broken  down  (decalcified),  the  tubuli  of  the 
exposed  area  of  dentine  is  invaded  by,  and  forms  a  habitat  for, 
many  varieties  of  micro-organisms. 

The  micro-organisms  active  in  the  destruction  or  decalci- 
fication of  tooth  structure  are:  (1)  Those  of  fermentation — ^the 


Fig.   21. — Ceoss    Section    Showing  a   Beeaking  ok  Melting  Down   of 
Intektubulae    Substance.   (Bax-rett    after    Mummery.) 


yeast-plant,  a  vegetable  fungus;  (2)  those  responsible  for  de- 
struction of  the  dentine — the  bacilli  (a  cylindrical  or  rod-like 
form  of  bacteria).  These  micro-organisms  do  not  act"  directly 
upon  the  dentine,  but  in  the  act  of  their  multiplication — and 
they  multiply  in  a  cavity  of  decay  by  the  millions, — ^their  pro- 
duct is  an  acid,  which,  in  its  turn,  attacks  and  decalcifies  and 
disorganizes  the  dentine. 

Dental  caries  then  may  be  accepted  as  a  germ  disease,  re- 
sulting from  infection.     The  germs  are  propagated  and  com- 


DISEASES    OF    THE    HARD    DENTAL    STRUCTURE.  51 

niunicated  to  the  interior  of  the  tooth  first  by  fermentation  of 
food  particles  which,  lodging  between  the  teeth  or  in  some 
irregularity  of  the  surface  of  the  enamel.  This  ferment  com- 
bined with  the  moisture  and  temperature  of  the  mouth,  forms 
an  excellent  media  for  the  proliferation  of  low  forms  of  life, 
and  at  once  becomes  infested  with  certain  acid  producing  fungi. 
These  germs  form  lodgment  wherever  they  are  not  frequently 
disturbed,  it  may  be  in  fissures  or  pits,  under  clasps  of  partial 
plates  or  ill-fitting  crowns,  or  between  the  teeth.  They  form 
glutinous  or  felt-like  masses,  quite  adhesive  to  the  enamel, 
which  excrete  lactic  acid  and  owing  to  the  thick  plaque  or  mass 
of  fungi  this  acid  is  prevented  from  being  washed  away  and  has 
an  opportunity  to  exert  its  full  solvent  action  upon  the  enamel 
rods. 

After  decalcification  once  starts  so  as  to  give  a  depressed  and 
softened  area  the  destructive  work  progresses  more  rapidly, 
proceeding  along  the  line  of  the  enamel  rods.  The  bacteria 
grow  into  the  spaces  formed  by  the  destruction  of  the  interpris- 
matic  cement,  or  the  animal  portion  of  the  enamel,  causing  a 
breaking  down  and  dislodgment  of  masses  of  partially  decalci- 
fied enamel,  thus  hastening  the  cavity  formation.  The  organ- 
isms, it  will  be  noted,  do  not  in  themselves  attack  the  tooth,  but 
their  product,  lactic  acid,  being  the  solvent;  they  are  therefore 
only  indirectly  responsible. 

When  the  dentine  becomes  exposed  through  the  process  of 
caries  the  tubules  at  the  exposed  surface  become  infested  with 
the  bacilli  referred  to  above,  which  in  their  multiplication  pro- 
duce or  excrete  lactic  acid  resulting  in  the  decalcification,  and 
in  time  the  disorganization  of  the  dentine.  This  process  is 
shown  in  Figs.  20  and  21. 

The  predisposing  causes  of  dental  caries  are  numerous, 
and  are  in  nearly  all  cases  due  to  constitutional  or  systemic 
disturbances.     The  character  of  the  structure  of  the  teeth  re- 


52  DENTAL  PATHOLOGY  AND  DENTAL  MEDICINE. 

garding  both  the  quality  and  quantity  of  the  several  tissues  is 
an  important  factor;  this  is  well  illustrated  by  the  interglobular 
spaces  frequently  met  with  both  in  the  enamel  and  dentine. 
These  spaces  are  the  result  of  some  systemic  disturbance  during 
the  period  of  calcification  of  the  teeth,  and  later  form  weak 
points,  or  are  predisposing  causes  of  caries.  The  position  of  the 
teeth,  too,  is  often  a  factor  in  the  frequency  of  caries  in  these 
organs;  that  is,  whether  they  stand  so  that  all  surfaces  may  be 
readily  cleansed,  or  very  irregularly,  presenting  numerous  sur- 
faces for  the  lodgment  of  fermentable  substances.  The  general 
tone  of  the  system,  whether  giving  to  these  organs  their  needed 
nourishment,  or  a  nerve  or  blood  supply  of  a  sluggish  nature, 
the  effects  of  illness,  and  the  relation  of  sex  also  presents  certain 
predisposing  characteristics. 

Dental  Caries  During  Illness. — In  severe  illness,  several 
conditions  favor  dental  caries:  1st,  the  lack  of  nutrition  causes 
the  teeth  to  be  less  able  to  resist  destructive  influences;  2d,  the 
abnormal  acid  secretion  aids  in  the  destruction  of  the  tooth 
substance;  3d,  fermentation  often  progresses  about  the  tooth 
without  hindrance,  on  account  of  the  patient's  inability  to  keep 
the  surface  properly  cleansed. 

During  childhood,  when  the  nervous  system  is  in  an  ex- 
alted state,  owing  to  the  developmental  changes  of  this  period, 
and  frequently  from  excessive  mental  strain  following  too  close 
confinement  and  over  study,  we  have  a  disturbance  of  the  nutri- 
tive functions  and  a  lowering  of  the  general  tone  of  the  system, 
which  must  be  recognized  a  predisposing  cause  of  caries. 

Dental  Caries  in  Its  Relation  to  Sex. — In  the  male  adult 
the  conditions  are  more  favorable  than  in  the  female.  The 
male  usually  uses  his  teeth  more  in  mastication,  and  partakes 
of  sweets  less  frequently  between  meals,  there  being  a  less  de- 
sire for  saccharine  and  farinaceous  foods.  Particles  of  food 
collecting  about  the  teeth  are  readily  converted  into  lactic  acid, 
thus  becoming  injurious  to  the  tooth  substance.. 


DISEASES    OF    THE    HARD    DENTAL    STRUCTURE.  53 

M.  Parreidt,  in  writing  upon  this  subject,  says: — 
"The  female  is  also  at  a  disadvantage  during  pregnancy,  at 
which  time  a  large  quantity  of  lime  phosphates  are  essential  to 
the  growth  of  the  fetus,  and  this  supply  is  diverted  from  the 
teeth.  It  is  well  known  that  during  pregnancy  fractures  heal 
less  readily,  because  the  lime  phosphates  are  needed  for  the 
fetus.  If,  in  a  similar  manner,  the  nourishment  of  the  teeth 
is  affected,  as  during  the  healing  of  fractures,  one  may  readily 
conceive  that  their  power  of  resistance  against  unhealthy  influ- 
ences must  be  materially  diminished,  and  the  reactions  of  the 


Fig.  22. 

oral  fluids  during  pregnancy  are  not  infrequently  acid.  Finally, 
in  these  cases,  the  reflex  disturbances  of  digestion  should  be 
considered  also,  for  the  acid  eructations  are  also  injurious  to 
the  teeth." 

Poorly  organized  or  "soft  teeth"  offer  a  strong  predispo- 
sition to  dental  decay.  Careful  analyses  may  show  one  tooth  to 
contain  the  same  amount  of  the  calcium  salts  as  another,  yet 
owing  to  the  structural  organization  we  may  find  in  applying 
the  burr  or  chisel,  great  differences  in  resistance,  similar  to 
that  shown  in  chalk  and  marble.  A  tooth  poorly  organized, 
therefore,  will  succumb  sooner  than  the  one  with  a  more  com- 
pletely organized  structure. 

Structural  defects  in  the  enamel,  without  reference  to  cause, 
is  a  predisposing  factor  in  the  decay  of  the  tooth.  These  de- 
fects may  be  too  small  to  be  noticed  by  the  operator,  yet  are  of 
sufficient  size  to  give  lodgment  to  colonies  of  micro-organisms. 


54 


DENTAL  PATHOLOGY  AND  DENTAL  MEDICINE. 


There  are,  however,  other  and  more  apparent  defects  fre- 
quently met  with.  Nutritive  disturbance  during  the  calcifica- 
tion of  the  teeth  has  been  referred  to ;  if  this  is  the  result  of  a 
prolonged  illness  it  is  apt  to  produce  a  line  of  pits  or  a  groove 


Fig.  23. 

across  the  face  of  the  tooth  indicating  the  point  where  calcifi- 
cation was  progressing  when  nutrition  was  disturbed.  (Fig.  22.) 
Cases  are  also  met  with  where  there  may  be  several  rows  of  pits, 
or  a  completely  roughened  surface,  indicating  repeated  Reasons 
of  nutritive  disturbances  during  early  childhood.     (Fig.  23.) 

Quite  a  different  malformation  of  the  face  and  edges  of  the 
teeth  is  that  resulting  from  inherited  syphilis.  Teeth  of  this 
character  are,  owing  to  their  very  irregular  surfaces,  prone  to 
caries.     This  effect  of  inherited  syphilis  was  first  called  atten- 


FlG.  24. 

tion  to  by  Jonathan  Hutchinson,  and  today  the  condition  is 
frequently  referred  to  as  Hutchinson's  teeth. 

This  condition  is  illustrated  in  Fig.  24,  which  will  aid  the 
student  in  more  readily  distinguishing  between  these  structural 
defects. 


DISEASES    OF    THE    HARD   DENTAL    STRUCTURE. 


55 


The  proximal  surfaces  are  convenient  positions  for  the 
lodgment  of  fermentable  substances;  in  consequence,  fully  65 
per  cent,  of  the  first  appearances  of  caries  occur  on  these  sur- 
faces of  the  teeth.  From  statistical  examinations  made 
by  the  writer  of  one  hundred  thousand  permanent  teeth,  dental 
caries  may  be  classified  in  the  folowing  groups: — 


Per  cent. 


Superior  central  incisors, caiious 

Inferior         "  "  

Superior  lateral        "  

Inferior         "  "  

Superior  cuspids,  

Inferior         "  

Superior   flrst    bicuspids, 

Inferior        "  "  

Superior    second    bicuspids 

Inferior  "  "  

Superior   first    molar, 

Inferior       "  "  

Superior   second   molar 

Inferior  "  "  

Superior  third         " 

Inferior        "  "  . 


.144 

.006 

.14 

.008 

.07 

.009 

.10 

.05 

.08 

.05 

.16 

.145 

.11 

.12 

.025 

.03 


Relative    Location    of   Dental    Caries. 


Superior  central   incisors, 
lateral        " 
cuspids, 
"    flrst  bicuspids, 
second     " 
first  molars, 
second  " 
third     " 


Inferior  central  incisors, 
lateral        " 
cuspids, 
"  first  bicuspids, 

"  second     " 

"  first  molars, 

"  second  " 

third     " 


Approx.     La.        Pal.      Mas. 


.95 

.94 
.98 
.93 
.92 
.35 
.20 
.04 


.99 
.98 
.95 
.91 
.91 
.30 
.16 
.02 


.01 

.01 

.015 

.005 

.005 


Approx.     La. 


.01 

.02 

.045 

.01 

.005 


.04 
.05 
.005 


Lin. 


.005 


.065 

.075 

.61 

.75 

.95 


.08 

.085 

.64 

.78 

.95 


Bug. 


.04 
.05 
.01 


Mas.       Bug. 


.06 
.06 
.03 


Note.— The  above  tables  are  made  without  respect  to  age  or  sex. 


56  DENTAL  PATHOLOGY  AND  DENTAL  MEDICINE. 

Therapeutics  of  Dental  Caries. — The  most  effective  treat- 
ment of  caries  consists  in  the  removal  of  the  diseased  portions 
and  the  proper  preparations  of  the  cavity,  followed  by  a  well- 
inserted  filling  of  the  least  destructible  substance  compatible 
to  the  case  in  hand.  There  .are  exceptional  cases,  however, 
where  decay  does  not  extend  into  the  dentine — where  the  tooth 
may  be  preserved  by  removing  the  diseased  parts  with  a  fine 
stone,  diamond  disk,  or  diamond  point,  and  leaving  the  surface 
thus  treated  well  polished. 

Prophylaxis. — From  the  time  of  the  eruption  of  the  decid- 
uous teeth  the  mouth  should  be  kept  scrupulously  clean.  A 
soft  or  medium  brush  and  water  should  be  employed  daily  after 
each  meal,  and  with  a  good  powder  upon  rising  in  the  morning 
and  just  before  retiring  at  night.  Where  the  teeth  are  so  closely 
situated  that  the  brush  cannot  be  worked  between  them,  so  as  to 
cleanse  the  proximal  surfaces,  floss  silk  or  quill  toothpicks  should 
be  used  to  remove  any  particles  of  food  that  become  lodged  be- 
tween the  teeth. 

Mouth-washes. — AU^aline  mouth-washes,  such  as  milk  of 
magnesia,  lime-water,  or  bicarbonate  of  soda  in  solution,  are 
sometimes  used;  not,  however,  as  a  substitute  for  the  tooth 
brush  and  dentifrice,  but  as  an  adjunct.  They  temporarily 
neutralize  the  oral  fluids  when  of  an  acid  reaction. 

Dental  Abrasion. 
Odontalgia  (tooth  pain)  is  not  infrequently  caused  by 
sensitive  dentine  on  the  abraded  or  worn-down  masticating 
surfaces  of  the  teeth;  the  enamel  covering  being  removed,  irri- 
tation is  more  readily  carried  to  the  pulp.  If  the  irritation  is 
very  severe,  and  is  continued  for  a  considerable  length  of  time, 
it  may  cause  acute  inftammation  and  lead  to  the  death  of  the 
pulp.  This  condition,  however,  usually  shows  itself  when  there 
is  a  strong  calcic  diathesis.  That  is,  where  there  is  superabund- 
ance of  lime  in  the  system,  making  the  teeth  hard,  and  some- 


INJURIES   AND  DISEASES   OF  THE  MAXILLARY  BONES.  57 

times  more  or  less  brittle.  Owing  to  this  excess  of  lime,  the 
pulp,  in  these  cases,  generally  responds  to  the  irritation  by 
throwing  out  a  deposit  of  secondary  dentine  proportionate  to 
the  advance  of  the  abrasion.  Abrasion,  as  has  been  indicated, 
is  a  mechanical  action,  and  should  not  be  confounded  with 
erosion,  which  is  the  result  of  a  chemical  action. 

Treatment. — Apply  to  the  abraded  surface  chloride  of  zinc 
crystals,  or  rub  the  sensitive  points  with  nitrate  of  silver,  and 
follow,  when  practicable,  by  building  up  the  surface  with  gold ; 
also  make  application  of  a  counter-irritant  and  stimulant  to  the 
gums  about  the  abraded  teeth. 


INJTIKIES  AND  DISEASES   OF  THE  MAXILLAEY 

BONES. 

Fractures  of  the  Lower  Jaw. 

Fractures  of  the  lower  jaw  are  usually  the  result  of  di- 
rect violence,  such  as  a  kick  from  a  horse,  fall  from  a  height 
upon  the  face,  the  unskillful  application  of  the  dental  "key" 
and  forceps,  etc.  Professor  Pancoast,  however,  met  with  a 
case  in  which  the  neck  of  the  bone  was  fractured  by  a  violent 
fit  of  coughing."^ 

The  Most  Frequent  Location. — ^Fractures  occur  most  fre- 
quently in  the  neighborhood  of  the  cuspid  tooth,  this  position 
being  determined  by  the  weakness  of  the  bone  at  this  point,  in 
consequence  of  the  depth  of  the  alveoli. 

Fractures  of  the  alveolus  are  frequently  unavoidable  dur- 
ing the  extraction  of  teeth.  The  displacement  of  portions  of 
this  bone,,  however,  gives  little  inconvenience,  and  hastens  the 
resorptive  process;  but,  should  the  fracture  affect  the  alveoli  of 
the  adjoining  teeth,  a  troublesome  exfoliation  may  follow. 
Since  accidents  of  this  kind  are  due  to  the  natural  eonforma- 

♦Gross'  "Surgery." 


58  DENTAL  PATHOLOGY  AND  DENTAL  MEDICINE. 

tion  of  the  parts,  legal  proceedings  against  the  operator  for 
this  mishap  are  most  unjust. 

Diagnosis. — fractures  of  the  lower  jaw  are  readily  recog- 
nized; the  regularity  of  the  dental  arch  is  altered,  and  the 
mobility  of  the  fractured  portions  is  shown  when  pressure  is 
applied  to  the  teeth  or  alveolar  process  at  the  site  of  pain. 

Crepitation  is  discernible  during  the  first  week  after  frac- 
ture. Its  absence,  after  this  time,  is  due  to  formations  of  gran- 
ulations and  of  the  partial  union  of  the  fractured  ends. 

The  gums,  also,  are  usually  lacerated  at  the  point  of  frac- 
ture, accompanied  by  considerable  inflammation  and  swelling. 

Fracture  of  the  ramus  of  the  jaw  is  less  frequent  than 
in  the  body,  and  is  not  so  readily  diagnosed,  as  the  upper  por- 
tion cannot  be  grasped  with  the  fingers,  and  crepitation  is 
difficult  to  make  out. 

Treatment. — The  appliances  used  for  the  maintenance  of 
the  fractured  portions  in  position  may  be  divided  into  two 
classes : — 

External  and  internal  to  the  mouth,  though  it  may  be,  in 
a  few  instances,  necessary  to  combine  the  two  methods.  The 
simplest  form  of  apparatus  for  external  use  is  the  ordinary 
four-tailed  bandage  or  sling,  with  a  split  for  the  chin  to  rest 
in.  It  is  made  from  a  piece  of  muslin,  about  a  yard  in  length 
and  two  or  three  inches  broad;  this  should  have  "a  slit  four 
inches  long  cut  in  the  center  of  it,  parallel  to,  and  an  inch  from, 
the  edge.  The  end  of  the  bandage  should  then  be  split  to  within 
a  couple  of  inches  of  the  slit,  thus  forming  a  four-tailed  band- 
age, with  a  hole  in  the  middle.  The  central  slit  can  be  readily 
adapted  to  the  chin,  the  narrow  portion  going  in  front  of  the 
lower  lip,  and  the  broader  beneath  the  jaw,  and  the  two  tails 
corresponding  to  the  lower  part  of  the  bandage  are  then  to  be 
carried  over  the  top  of  the  head,  while  the  others  are  crossed 
over  them  and  tied  round  the  nape  of  the  neck.  The  ends  of 
the  two  bandages  may  then  be  knotted  together"  (Heath). 


INJURIES  AND  DISEASES   OF  THE  MAXILLARY  BONES.  59 

Hamilton  has  devised  a  sling  for  which  he  claims  superi- 
ority; we  give  it  in  his  own  words:  "The  advantage  of  this 
dressing  over  any  which  I  have  yet  seen  consists  in  its  capability 
to  lift  the  anterior  fragment  vertically,  and  at  the  same  time  it 
is  in  no  danger  of  falling  forward  and  downward  upon  the  fore- 
head. If,  as  in  the  case  of  most  other  dressings,  the  occipital 
stay  had  its  attachment  opposite  the  chin,  its  effect  would  be  to 
draw  the  central  fragment  backward.  By  using  a  firm  piece  of 
leather  as  a  maxillary  band,  and  attaching  the  occipital  stay 
above  the  ears,  this  difficulty  is  completely  obviated." 

The  interdental  splint  is  an  apparatus  used  in  common 
among  dentists  for  an  internal  appliance  in  the  treatment  of 
fractured  maxillae.  It  is  usually  made  of  vulcanite  rubber,  and 
gives  very  satisfactory  results.  In  1866,  Mr.  Gunning,  of  New 
York,  gave  a  description  of  this  contrivance  as  then  used  by 
him.* 

Method  of  Making  Single  Interdental  Splint.— Take 
impression  in  wax  or  modeling  compound,  using  as  small  an 
amount  as  will  insure  a  good  impression  of  the  teeth  and  gums. 
An  assistant  should  stand  behind  the  patient  and  hold  the  broken 
bone  as  near  in  place  as  can  be  done  with  any  degree  of  com- 
fort to  the  patient,  while  the  operator  stands  directly  in  front 
and  takes  impression.  After  the  casts  of  both  jaws  have  been 
secured,  they  should  be  carefully  articulated.  This  is  done  by 
cutting  with  a  small  saw  the  lower  cast  at  the  point  or  points  of 
fracture,  and  rearranging  the  sections  thus  made,  so  as  to  bring 
the  teeth  into  correct  articulation.  The  pieces  should  then  be 
secured  in  this  position  with  plaster-of-Paris,  and  the  two 
models  placed  in  an  articulator.  The  casts  are  then  covered 
with  No.  60  tinfoil;  this  makes  the  cavities  in  the  splint  a  little 
larger  than  the  corresponding  teeth,  making  it  easily  adjusted, 
and  leaves  it  with  a  smooth  surface.  Use  two  thicknesses  of 
base-plate  wax  over  the  tinfoil,  allowing  it  to  pass  down  a  trifle 

♦New  York  Medical  Journal  and  British  Journal  of  Dental  Science. 


60  DENTAL  PATHOLOGY  AND  DENTAL  MEDICINE. 

below  the  necks  of  the  teeth.  Flask  and  vulcanize  in  usual 
manner  for  rubber  work. 

When  the  fracture  is  of  an  obstinate  vertical  nature,  a  splint 
that  will  enclose  the  teeth  and  gnms  of  the  upper  jaw  at  well 
as  the  lower  should  be  used.  When  the  proper  treatment  is 
employed,  a  cure  is  effected  in  from  six  to  eight  weeks,  accord- 
ing to  the  age  and  physical  condition  of  the  patient. 

Fractures  of  the  upper  jaw  are  less  frequent  and  less  diffi- 
cult of  treatment  than  those  of  the  lower  jaw.  In  recent  cases 
a  simple  replacement  of  the  parts  is  all  that  is  necessary,  and 
occasionally  the  application  of  a  simple  retention  splint  is  em- 
ployed. 

Angle's  Method  of  Fixation. — A  more  recent  method  for 
treatment  of  fractures  of  the  maxillae  is  that  devised  by  Dr. 
E.  H.  Angle.  For  a  detailed  description  of  this  method,  to- 
gether with  that  of  the  interdental  splint,  the  student  is  re- 
ferred to  Richardson's  "Mechanical  Dentistry,"  seventh  edition. 

Necrosis  of  the  Jaws. 

Necrosis  of  the  jaw  is  indicated  by  inflammation,  similar 
to  that  of  dental  periostitis.  The  gum  about  the  affected  part 
is  swollen  and  of  a  dark-red  or  purple  color,  pus  oozing  from 
the  edge  of  the  gum  between  the  teeth,  or  through  one  or  more 
fistulous  openings;  this  discharge  is  not  always  confined  to 
the  mouth;  we  find  the  pus  escaping  sometimes  through  an 
opening  on  the  cheek  or  neck,  as  low  do^vn  at  times  as  the 
clavicle. 

The  effect  of  necrosis  of  the  jaw  upon  the  teeth  is 
obvious,  since  great  pain  is  produced  by  the  least  pressure,  and 
in  cases  of  entire  necrosis  they  become  loose  and  discolored; 
in  the  majority  of  such  cases  the  teeth  prove  such  an  annoy- 
ance to  the  patient  that  they  are  extracted,  if  they  do  not  drop 
out  of  their  own  accord. 

Treatment. — Remove  the  dead  portions  from  around  the 
living  bone, — here  the   dental  engine   and   burrs   are  useful, — 


INJURIES  AND  DISEASES   OF  THE  MAXILLARY  BONES.  61 

syringe  with  tepid  water  and  peroxide  of  hydrogen  to  cleanse 
the  parts,  followed  by  stimulants,  tonics,  and  nourishing  diet. 

New  bone  is  produced  in  the  lower  jaw  if  the  periosteum 
is  preserved,  this  with  the  surrounding  tissue  being  active  in 
producing  new  bone  to  take  the  place  of  the  lost  portion. 

In  the  superior  maxillary  there  is  a  development  of  fibrous 
tissue  in  the  young  subject.  In  the  adult,  nature  does  not  do 
this  much.  When  a  part  of  the  superior  maxillary  is  necrosed, 
the  periosteum  ordinarily  makes  no  effort  to  renew  the  lost 
bone.  (Eor  an  elaboration  upon  this  subject  see  Heath's  "Dis- 
eases of  the  Jaw.") 

Dislocation  of  the  Lower  Jaw. 

The  causes  of  dislocation  of  the  lower  jaw  are  yawning, 
shouting,  vomiting,  the  introduction  of  the  stomach  pumpj  etc. 
Sometimes  it  occurs  during  operations  upon  the  teeth;  in  all 
cases  the  patient's  mouth  is  opened  to  its  fullest  extent.  The 
capsular  ligament,  being  very  large  and  tenacious,  is  not 
ruptured. 

The  manner  in  which  dislocation  takes  place  is  as  fol- 
lows :  When  the  mouth  is  opened  to  its  fullest  extent,  each  con- 
dyle of  the  jaw  leaves  the  true  articular  eminence  of  the  inter- 
articular  fibro-cartilage,  which  is  drawn  forward  of  the  external 
pterygoid  muscle.  A  cavity  is  thus  left  behind  the  condyle; 
when  the  jaw  is  in  this  position,  but  very  slight  force  is  needed 
to  carry  the  condyle  over  the  articular  eminence,  producing  a 
dislocation. 

Symptoms  of  Dislocation. — The  mouth  is  open  and  the 
jaw  fixed,  mastication  being  impossible,  as  the  lower  teeth  pro- 
ject beyond  those  of  the  upper  jaw.  Saliva  dribbles  from  the 
mouth,  and  speech  is  indistinct.  A  careful  examination  reveals 
a  concavity  immediately  in  front  of  the  ear,  and  the  condyle 
may  be  both  seen  and  felt  in  front  of  this.  The  masseter  muscle 
is  firmly  contracted  and  very  prominent  (see  Fig.  25). 


62 


DENTAL   PATHOLOGY  AND  DENTAL   MEDICINE. 


Treatment. — Reduction  is  made  by  placing  the  thumbs 
(protected  by  napkins)  as  far  back  upon  the  molars  as  possible 
(see  Fig.  26),  depressing  the  back  part  of  the  jaw,  followed  at 
once  by  the  raising  of  the  chin,  which  results  in  sliding  the 
the  dislocation  the  jaws  should  be  secured  by  a  bandage  extend- 
ing under  the  chin  and  over  the  top  of  the  head.  The  patient 
capitulum  backward  into  the  condyle  fossa.     After  correcting 


Fig.    25. — Dislocation    of 
Lower     Jaw. —  (Bryant.) 


Fig.    26.- — Reduction    of    Dis- 
liOCATiON   of    Lower    Jaw. — 
(Bryant.) 


should  be  recommended  to  take  care,  for  some  weeks,  not  to 
open  the  mouth  too  far,  as  a  disposition  to  a  recurrence  is  great. 

Inflammation  of  the  Temporo-maxillary  Articulation. 

Serious  inflammation  of  the  temporo-maxillary  articulation 
is  infrequent;  when  such  complaint  arises,  it  is  usually  found 
that  some  derangement  of  the  teeth  is  the  seat  of  the  trouble; 
however,  when  by  a  close  examination  we  find  the  teeth  and 
their  surrounding  tissues  in  an  apparently  good  condition,  in- 
flammation of  this  articulation  may  be  surmised. 

Symptoms. — The  parts  in  the  vicinity  of  the  joint  are  sensi- 
tive to  pressure;  they  present  a  swollen  appearance  and  cause 
considerable  pain  when  the  mouth  is  opened  and  closed. 


INJURIES   A2s'D   DISEASES   OF  THE  MAXILLARY  BONES.  63 

Treatment. — First,  comparative  rest  must  be  given  the  joint, 
the  patient  partaking  only  of  liquid  or  soft  food.  An  applica- 
tion of  some  good  stimulant,  such  as  tincture  of  iodine,  followed 
by  ice-water  compresses,  to  decrease  the  heat  of  the  inflamed 
parts. 

Abscess  of  the  Antrum  of  Hjghmore. 

The  Maxillary  Sinus  or  so-called  Antrum  of  Highmore 
is  separated  from  the  apices  of  the  superior  molars  by  a  very 
thin  lamella  of  bone,  which  is  sometimes  penetrated  by  the 
roots  of  a  tooth;  usually  the  lii'st  molar.  This  sinus  or  cavity, 
situated  in  the  body  of  the  superior  maxilla  is  connected  with 
the  air  passages  of  the  nose  through  small  openings  in  the  sides 
of  this  organ.  By  this  portion  of  the  bone  being  hollow  contour 
is  given  to  the  face  without  adding  to  the  weight  of  the  bone. 
Its  principle  value,  however,  is  in  giving  resonance  to  the  voice ; 
in  fact  it  is  sometimes  referred  to  as  the  sounding  chamber  of 
the  human  voice. 

The  mucous  membrane  lining  this  cavity  is  continuous 
with  that  lining  the  nose — the  Scluieiderian  membrane.  Hence 
very  serious  nasal  inflammation  may  through  this  continuity 
of  tissue,  induce  antral  disorders.  Then  we  may  have  quite  the 
reverse,  nasal  inflammation  and  discharges  caused  by  suppura- 
tion in  the  antrum. 

At  times,  inflammation  from  alveolar  periostitis  extends  to 
the  mucous  membrane  of  the  antrum.  Again,  abscesses  are 
formed  in  the  antrum  by  the  septic  decomposition  of  the  pulp 
of  a  tooth  the  roots  of  which  extend  into  the  cavity,  or  the  ac- 
cumulation of  pus  about  the  apical  i^ortion  of  the  root  has  caused 
resorption  of  the  floor  of  the  antrum  sufficiently  to  allow  the  pus 
to  enter  this  chamber.  Fig.  27  shows  an  alveolar  abscess  at  the 
root  of  an  upper  molar  discharging  into  the  Antrum  of  High- 
more. 

When  this  takes  place,  the  natural  opening  between  the  an- 
trum and  the  nose  becomes  diminished  by  the  swelling  of  the 


64  DENTAL   PATHOLOGY   AND  DENTAL    MEDICINE. 

lining  mucous  membrane.  Inflammation  becomes  excessive, 
and  a  large  collection  of  pus  takes  place,  which  at  length  escapes 
into  the  nose,  or  burrows  -alongside  of  the  root  of  a  tooth  and 
discharges  into  the  mouth.  Or  a  fistula  may  be  established 
upon  the  cheek;  and  in  protracted  cases  the  floor  of  the  orbit 
may  give  way,  and  pus  discharge  along  the  lower  eyelid. 

Symptoms. — Whatever  the  source  of  the  antral  disease,  the 
phenomena  presented  are  about  the  same,  and  are  distinctive. 
The  patient  complains  of  a  feeling  of  fullness  or  pressure,  dull. 


Fig.  27. — a,  Abscess  Cavity  in  the  bone  ;  b,  Nostrum  ;   c,  Pus  in  the 

ANTRAl,   CAVITY. 

heavy  pains  on  the  affected  side  of  the  face,  and  if  the  trouble 
has  continued  for  a  considerable  length  of  time,  there  will  be 
a  discharge  of  pus  into  the  nose,  especially  while  in  a  recumbent 
position.  This  pus  is  usually  accompanied  by  a  bad  odor,  and 
at  times  causes  severe  local  and  constitutional  suffering.  The 
cheek  is  hot,  flushed,  and  somewhat  swollen;  and  when  the  an- 
trum becomes  filled  with  pus,  the  malar  bone  is  elevated,  with 
an  apparent  depression  beneath  it;  the  palate  in  severe  cases 
loses  its  concavity  and  becomes  convex,  and  the  floor  of  the 
orbit  is  pushed  up,  forcing  the  eye  partly  from  its  normal 
position. 

Treatment. — If  it  is  found  that  a  devitalized  pulp  is  the 
exciting  cause,  the  tooth  being  in  an  otherwise  good  condition, 
effort  should  be  made  to  preserve  it.     The  pulp  should  be  re- 


INJURIES  AND  DISEASES   OF  THE  MAXILLARY  BONES.  05 

moved,  roots  cleaned  and  temporarily  filled  with  some  antiseptic 
dressing. 

The  antrum  should  then  be  opened  by  penetrating  the  walls 
with  a  suitable  drill  revolved  by  the  dental  engine.  After  de- 
termining the  lowest  point  the  parts  should  be  anesthetized  with 
chloride  of  ethel  spray,  or  the  patient  may  be  given  nitrous 
oxide  of  gas.  The  drill  then  being  revolved  rapidly  will  enter 
in  a  few  seconds.  In  selecting  the  drill  for  this  purpose  one 
giving  an  entrance  large  enough  to  admit  the  nozzle  of  a  good- 
sized  rubber  syringe  should  be  employed. 

Good  drainage  having  been  secured,  the  cavity  should  be 
washed  with  warm  water  to  which  a  little  salt  has  been  added. 
The  nozzle  of  the  syringe  is  carefully  placed  in  the  opening 
until  it  reaches  the  antrum  when  firm  and  steady  pressure  will 
throw  the  contents  into  the  cavity.  The  syringe  should  be 
quickly  withdrawn  so  that  the  operator's  hands  will  not  inter- 
fere with  free  drainage  through  the  nose.  This  may  be  repeated 
until  the  cavity  is  quite  clean,  when  it  may  be  followed  with 
water  containing  a  little  peroxide  of  hydrogen.  Full  strength 
peroxide  of  hydrogen,  or  even  50  per  cent.,  would  cause  severe 
pain  owing  to  the  violent  foaming  in  a  pent-up  cavity. 

The  opening  may  be  maintained  for  treatment  by  the  in- 
sertion of  a  platinum  drainage  tube  or  a  plug  of  some  nature. 
This  treatment  should  be  renewed  every  second  day  for  a  short 
time,  then  gradually  decreased  as  the  case  demands. 

In  instances  where  the  condition  of  the  tooth  at  fault  is 
such  as  not  to  warrant  an  effort  to  save  it,  the  tooth  should  be 
extracted  and  the  antrum  entered  through  one  of  the  root 
sockets.  Where  there  are  complications,  such  as  serious  necrosis 
the  case  had  best  go  to  the  general  or  oral  surgeon. 

DEFECTS  OF  THE  PALATINE  OEGANS. 
Cleft  Palate. — One  of  the  most  distressing  deformities  to 
which  the  human  frame  is  liable  is  that  defective  condition  of 
the  palatine  organs  known  as  Cleft  Palate. 


66  DENTAL   PATHOLOGY  AND  DENTAL   MEDICINE. 

It  is  indicated  by  a  fissure  extending  through  the  soft,  or 
both  the  soft  and  hard,  palate,  causing  an  impairment  of  mas- 
tication, of  deglutition,  and  of  speech.  They  are  divided  into 
two  classes — Acquired  (by  accident  or  disease),  and  Congenital 
(dating  from  birth). 

Congenital  cleft  palate  is  the  result  of  a  lack  of  develop- 
ment of  the  maxillary  bones,  which  may  be  caused  by  hereditary 
disease,  or  malformation  from  lack  of  nourishment  of  the 
tissues  involved  during  embryonic  life.* 

These  defects  are  sometimes  accompanied  by  more  or  less 
deformity  of  the  alveolar  arch  and  of  the  teeth,  which  are 
usually  of  a  soft  texture,  with  imperfectly  developed  roots.  The 
cleft  is  not  always  confined  to  the  palate  bones  and  the  soft 
palate,  but  may  be  complicated  with  complete  fissure  of  the 
alveolar  process  and  with  harelip. 

Acquired  cleft  palate  includes  all  losses  of  tissue  in  either 
soft  or  hard  palate  that  are  not  congenital,  whether  occasioned 
by  disease  or  accident.  The  faculty  of  distinct  articulate  speech 
is  impaired,  and  deglutition  is  performed  with  much  incon- 
venience; acquired  lesions  coming  generally  in  adult  life,  the 
individual  has  not  the  advantage  of  the  training  of  the  parts 
during  infancy,  as  in  cases  of  congenital  defects. 

The  infant  resorts  to  a  very  curious  expedient  to  secure  the 
nourishment  necessary  for  subsistence  and  growth.  The  nip- 
ple, instead  of  being  taken  between  the  tongue,  upper  lip,  and 
gum,  is  taken  between  the  lower  surface  of  the  tongue,  and  the 
lower  lip  and  gum.  This  habit  being  acquired,  it  is  applied 
later  in  the  mastication  of  solid  food.  The  food  being  conveyed 
between  the  tongue  and  movable  floor,  is  brought  back  between 
the  teeth  for  deglutition,  which  is  usually  performed  in  this 
way  without  any  food  entering  the  nose  through  the  cleft  palate. 

Treatment. — The  remedy  for  these  deformities  must  be  the 
closing  of  the  passage  in  such  a  way  as  to  restore,  as  far  as 

*See  article  on  "Physiology  of  Voice  and  Speech,"  "American  System 
of  Dentistry,"  Vol.  III. 


DEFECTS  OF  THE   PALATINE  ORGANS.  6'7 

possible,  to  the  organs,  their  functions.    This  may  be  done  by  a 
surgical  operation  or  by  the  insertion  of  an  artificial  palate. 

Staphylorrhaphy. 

The  surgical  operation  sometimes  resorted  to  is  an  ex- 
ceedingly painful  one  for  the  patient  and  difficult  for  the  oper- 
ator, and  which,  after  all,  often  proves  a  failure.  Indeed,  it  is 
claimed  by  some  writers  that  failures  of  closure  in  these  opera- 
tions are  in  the  majority.  However  this  may  be,  there  are  many 
cases  on  record  where  such  operations  have  been  performed  with 
a  marked  degree  of  success. 

Staphylorrhaphy  is  derived  from  a  Greek  word  signifying 
suture  of  the  uvula.  It  consists  in  freshening  or  paring  the 
edges  of  the  palate  and  passing  ligatures  or  sutures  through, 
drawing  the  edges  together,  and  closing  the  gap  by  tying  the 
sutures.* 

It  is  claimed  that  the  idea  of  this  operation  was  first  con- 
ceived by  one  Le  Monnier,  an  ingenious  French  dentist,  and 
was  successfully  performed  by  him  as  early  as  1764.  It  does 
not  seem  to  have  been  recognized  by  the  medical  profession, 
however,  for  more  than  half  a  century  afterward;  it  was  then, 
in  1820,  practiced  by  M.  Eoux,  in  France,  and  in  America  by 
Dr.  J.  C.  Warren,  of  Boston. 

Dr.  Warren's  methods  were  considered  simpler,  and  his  opera- 
tions are  generally  regarded  as  the  basis  of  the  various  modi- 
fications that  have  since  aided  in  perfecting  the  procedure,  and 
it  is  now  classed  among  the  regular  operations  of  surgery. 

Artificial  Palates. 
Artificial    palates,    according    to    some    writers,    were    em- 
ployed by  the  Greek  physicians,  but  the  first  description  was 
given  by  the  celebrated  French  surgeon,  Ambrose  Pare,  in  the 
early  part  of  the  sixteenth  century.     Many  improvements  upon 

*For  full  treatment  of  this  operation  see  "American  System  of  Den- 
tistry,"  Vol.   III. 


63  DENTAL   PATHOLOGY   AND  DENTAL   MEDICINE. 

these  primitive  forms  have  been  made.  They  are  divided  into 
two  distinct  classes — obturators  and  artificial  velum.* 

An  obturator  is  a  non-elastic  and  stationary  cover  or  stopper 
for  those  defects  in  the  hard  or  soft  palate  which  have  a  com- 
plete and  well  defined  boundary. 

An  artificial  velumf  is  a  movable  valve,  made  to  supply  the 
loss  of  the  posterior  soft  palate;  being  under  the  control  of  the 
surrounding  muscles,  opening  or  closing  the  passage  at  will. 

EXTKACTION  OF  TEETH. 

The  extraction  of  teeth  is  an  operation  that  need  seldom 
be  resorted  to.  It  is,  in  nearly  all  cases,  from  negligence  of  the 
patients  or  their  fear  of  dental  operations  that  the  teeth  are 
permitted  to  remain  in  diseased  conditions  until  they  reach  such 
a  state  that  extraction  is  necessary.  It  is  not  surprising  that 
the  operation  is  usually  approached  with  apprehension,  since 
frequent  accidents  occur  in  its  performance;  this,  however,  is 
generally  due  to  the  neglect,  awkwardness,  or  unskilfulness  of 
the  operator.  It  very  often  occurs  in  the  hands  of  medical  prac- 
titioners, and  is  a  subject  that  should  receive  more  attention 
from  physicians,  by  whom,  though  not  belonging  to  their  pro- 
vince, it  is  frequently  performed. 

Indications  Justifying  the  Operation. — First,  with  the 
teeth  of  first  dentition,  it  is  sufficient  to  state  that  when  a  tooth 
of  replacement  is  about  to  be  erupted,  or  has  actually  made  its 
appearance,  either  in  front  or  behind  the  corresponding  decidu- 
ous tooth,  the  latter  should  at  once  be  extracted ;  and  when  these 
teeth  have  been  so  neglected  that  they,  together  with  the  sur- 
rounding tissue,  have  become  seriously  diseased,  it  is  best  that 
they  should  be  removed.  It  is  desirable,  however,  whenever  they 
can  be  retained  in  a  fair  state  of  health,  to  do  so,  retaining  the 
shape  of  the  arch  until  it  is  time  for  their  successors  to  replace 

*See  Richai'dson's  "Mechanical  Dentistry,"  seventh  edition. 
tVelum :  a  veil,  a  cover ;  hence,  "a  pendulous  veil  of  the  palate." 


EXTRACTION   OF   TEETH.  69 

them,  as  well  as  gisdng  the  child  their  service  in  mastication. 

Second.  In  regard  to  the  propriety  of  extracting  the  perma- 
nent teeth,  it  should  first  be  stated  that  none  of  these  should  be 
sacrificed  unless  called  for  by  some  urgent  necessity.  Uncon- 
trollable pain  and  incurable  disease  surrounding  the  tooth  are 
instances. 

Third.  Extensive  loss  of  surrounding  tissue,  leaving  the  tooth 
or  root  very  much  loosened,  acting  as  in  irritant  and  becoming 
a  source  of  disease  to  the  rdjacent  parts. 

Fourth.  Where  a  tooth  is  the  cause  of  an  incurable  alveolar 
abscess,  the  offending  member  should  not  be  allowed  to  remain ; 
such  cases,  however,  are  rare. 

Fifth.  To  prevent  or  correct  irregularity  in  the  arrangement 
of  the  teeth. 

Sixth.  In  preparing  the  mouth  for  an  artificial  denture  it  is 
sometimes  found  that  the  loss  of  one  or  more  remaining  teeth 
may  be  advantageous. 

There  are  other  cases  presented  at  times,  to  which  fixed  rules 
would  not  be  applicable,  where  experienced  judgment  must  de- 
termine the  practice  to  pursue. 

In  conclusion,  it  is  scarcely  necessary  to  say  that  whenever 
a  tooth  can  be  restored  to  a  healthy  condition  it  should  always 
be  done,  and  that  we  should  not  for  any  reason  be  too  hasty  in 
extracting  the  first  tooth  from  an  unbroken  arch.  As  all  teeth, 
except  the  central  incisors  and  upper  third  molars,  have  nor- 
mally two  antagonists  in  articulation,  the  loss  of  one  tooth 
would  place  two  others  partially  without  function,  and  the  ad- 
joining teeth  would  soon  become  irregular  by  gradually  leaning 
into  the  spaces. 

Hemorrhage  after  Extraction. — In  cases  where  extraction 
is  folloived  hy  excessive  hemorrhage,  or  where  the  tendency  to 
hemorrhage  exists,  the  application  of  some  reliable  styptic 
should  be  made,  the  following  being  the  most  powerful  of  these 
agents :  tannic  acid,  solution  of  persulphate  of  iron,  and  the 
powdered   sulphate   of   iron    (Monsel's   powder),   or   adrenalin. 


70  DENTAL   PATHOLOGY  AND  DENTAL   MEDICINE. 

Some  of  the  simple  local  remedies  are  spider  web  or  a  pledget  of 
cotton  or  sponge  saturated  with  sandarach  varnish  as  mechani- 
cal obstructors ;  this  packing  should  be  allowed  to  remain  Tintil 
all  danger  of  a  return  is  past. 

DEPOSITS  UPON  THE  TEETH. 

The  simplest  form  of  deposit  upon  the  teeth  is  the  white, 
soft  accumulations  which  are  frequently  found  just  at  the  gum 
margins.  It  is  composed  of  partially  fermented  food  debris, 
mucous  and  micro-organisms.  These  organisms  are  without 
doubt  acid  producers,  though  slower  in  action  than  those  in- 
volved in  caries,  as  when  this  deposit  is  allowed  to  remain  for 
a  considerable  length  of  time,  the  enamel  surface  immediately 
beneath  it  will  be  found  to  be  decalcified. 

Green  stain,  more  frequently  found  in  the  moutljs  of  chil- 
dren, is  another  form  of  soft  deposit,  composed  of  certain  forms 
of  chromogenic  (color  producing)  bacteria,  intermixed  more  or 
less  with  a  growth  of  leptothrix  buccalis. 

This  fungus,  as  it  grows,  attaches  itself  to  roughened  sur- 
faces of  the  enamel,  or  to  surfaces  not  kept  scrupulously  clean 
and  polished.  Some  claim  that  its  attachment  and  action 
simply  involves  the  so-called  Nasmyth's  membrane,  but  clinical 
experience  would  indicate  that  where  it  is  allowed  to  remain 
for  a  long  while  it  has  a  solvent  action  upon  the  tooth,  as  the 
enamel  directly  beneath  it  will  be  more  or  less  roughened  from 
decalcification. 

While  these  deposits  are  called  green  stain,  there  are  several 
gradations  of  color,  which  is  caused  by  the  color  forming  bac- 
teria. In  older  persons  it  is  more  nearly  black  or  bronze  in 
color.  These  deposits  are  readily  removed  with  disks,  and  a  re- 
volving brush  and  pumice.  After  its  removal  any  eroded  sur- 
face of  enamel  should  be  dressed  down  and  polished. 

There  are  two  varieties  of  calculus,  or  tartar,  as  it  is 
most  commonly  called,  found  upon  the  teeth;  namely,  salivary 
and  sermnal  or  sanguinary. 


DEPOSITS   UPON   THE   TEETH.  Tl 

Salivary  calculus  is  deposited  from  the  saliva  upon  the 
crowns  or  any  exposed  surfaces  of  the  teeth.  It  varies  in  color 
from  a  light  cream  to  a  dark  brown  or  black,  depending  upon 
its  age  and  the  habits  and  general  health  of  the  patient.  The 
characteristics  of  the  substance,  therefore,  furnish  diagnoses  of 
importance  to  the  physician  and  dentist. 

Composition. — Salivary  calculus  is  composed  of  mineral  and 
animal  matter;  about  75  and  25  per  cent,  respectively.  Phos- 
phate of  lime,  and  in  some  cases  a  little  magnesia,  carbonate 
of  lime,  mucus,  and  a  small  quantity  of  animal  fat,  are  its 
principal  ingredients.  The  relative  proportions  of  its  constitu- 
ents very  according  to  its  density.  A  fair  average  is  expressed 
in  the  following  table: 

Calcium    phosphate, 65 

Calcium   carbonate,      ........  8 

Ferric  phosphate, 2 

Organic  matter,  leptothrix,  mucus,  etc.,    .      .  25 

All  persons  are  subject  to  salivary  calculus  to  a  greater  or 
less  extent,  but  its  physicial  characteristics  are  exceedingly 
variable.  Hence  it  is  that  analyses  made  of  it  by  different 
chemists  differ. 

Origin  and  Deposition. — It  is  generally  conceded  that  this 
concretion  is  a  deposit,  chiefly  from  the  saliva,  with  an  admix- 
ture of  mucus. 

Saliva  is  the  mixed  fluid  from  the  different  salivary  glands 
and  mucous  follicles,  and  in  its  normal  state  is  either  allvaline 
or  neutral.  On  exposure  to  the  atmosphere,  and  the  decomposi- 
tion liable  to  occur  in  the  mouth,  it  may  be  found  strongly  acid 
or  strongly  alkaline,  holding  salts  of  lime  in  solution.  On  the 
formation  of  acids  in  the  mouth,  and  by  the  action  of  the 
carbonic  acid  exhaled,*  decomposition  takes  place,  and  the  salts 

*  Carbonic  acid  having  a  strong  affinity  for  lime,  unites  with  it  in  the 
salivary  solution,   forming  carbonate  of   lime. 


72  DENTAL   PATHOLOGY   AND  DENTAL    MEDICINE. 

of  lime  are  deposited  upon  the  teeth.  Naturally,  it  is  precipi- 
tated in  great  quantities  upon  the  surfaces  of  the  teeth  opposite 
the  ducts  from  which  the  saliva  is  emptied,  upon  the  lingual 
surfaces  of  the  inferior  incisors  and  cuspids  (opposite  Whar- 
ton's duct),  and  the  buccal  surfaces  of  the  superior  molars,  in 
the  region  of  the  mouth  of  the  duct  of  Steno.  The  necks  of  the 
teeth  about  the  free  margins  of  the  gum  afford  favorable  points 
for  its  collection.  A  nucleus  once  being  formed,  it  deposits 
particle  by  particle,  rapidly  encroaching  upon  the  crown,  where 
it  is  deposited  more  abundantly.  In  the  mouths  of  uncleanly 
persons  it  sometimes  accumulates  in  such  quantities  that  nearly 
all  the  teeth  are  encrusted;  and  sometimes  several  of  the  teeth 
become  bound  together  in  one  mass. 

Salivary  calculus  is  not  deposited  upon  the  soft  tissues,  but 
upon  some  substance  that  forms  nuclei,  such  as  the  natural  and 
artificial  teeth,  plates,  etc. ;  though  it  is  found  sometimes  in  the 
ducts  of  the  salivary  glands,  owing,  no  doubt,  to  a  sluggish 
condition  of  the  saliva.  It  has  no  special  pathological  signifi- 
cance further  than  its  being  a  mechanical  irritant  to  the  gum 
tissue  and  alveolar  process  and  interferes  with  the  hygienic 
care  of  the  mouth. 

Treatment. — The  removal  of  salivary  calculus  is  an  opera- 
tion of  importance  to  the  health  of  the  gums  and  alveolar  pro- 
cess, and  the  preservation  of  the  teeth.  For  its  removal,  instru- 
ments (scalers)  that  may  be  readily  applied  to  every  part  of  the 
tooth  should  be  employed.  Considerable  tact  and  practice  are 
necessary  to  perform  the  operation  skillfully.  The  scaler  should 
be  passed  well  down  beneath  the  margin  of  the  gums — that  is, 
below  the  edge  of  the  deposit — until  it  is  brought  in  contact 
with  the  surface  of  the  tooth,  and  the  mass  scaled  off  in  the 
direction  of  the  cutting  or  masticating  surface.  Every  particle 
of  the  deposit  should  be  removed,  care  being  necessary  that  the 
tooth  substance  is  not  roughened  by  the  edge  of  the  instruments, 
and  the  surface  polished,  lest  nuclei  for  immediate  reaccumu- 
lation  be  left. 


DEPOSITS  UPON  THE  TEETH.  73 

Chemical  agents  are  employed  by  some  for  the  removal  of 
salivary  calculus.  This  should  be  scrupulously  avoided,  as  any 
acid  capable  of  dissolving  this  accumulation  is  more  or  less 
injurious  to  the  teeth.  "Their  careless  administration  by  physi- 
cians is  a  fruitful  source  of  injury  to  the  teeth,  and  they  cer- 
tainly should  form  no  part  of  any  dentifrice,  or  be  in  any  way 
used  for  the  removal  of  stains  of  any  kind  from  the  teeth." 
(Harris.) 

Salivary  calculi  are  concretions  sometimes  found  in  the 
ducts  above  referred  to.  These  deposits  are  formed  in  concen- 
tric layers,  are  more  or  less  irregular  in  shape  and  vary  in 
color  from  a  light  yellow  to  brown.  These  calculi  do  not  con- 
tain the  mucus  and  leptothrix  found  in  the  ordinary  calculus 
of  the  mouth,  having  about  the  following  composition : 

Calcium  phosphate, 75.0 

Calcium  carbonate 12.5 

Organic  matter, 12.5 

Sanguinary  calculus  is  deposited  upon  the  roots  of  the 
teeth,  and  not  upon  their  cro\\ms,  as  with  salivary  calculus.  It 
is  precipitated  from  the  liquor  sanguinis  of  the  blood,  following 
hyperemia,  which  may  be  caused  by  any  local  irritation.  It  is 
in  the  form  of  dark  granulations,  approaching  crystallization. 
It  is  much  harder  than  salivary  calculus,  and  adheres  more 
firmly.  The  attachment  is  so  close  sometimes,  as  to  practically 
make  it  necessary  to  chisel  it  away. 

Composition. — Sanguinary  calculus  is  composed  chiefly  of 
lime  salts,  colored  with  the  haematin  of  the  blood,  which  in- 
creases its  tendency  to  take  crystalline  form. 

It  should  be  remembered  that  while  salivary  calculus  causes 
inflammation,  sanguinary  calculus  is  a  result  of  the  inflamma- 
tory action. 

It  is,  however,  in  itself  distinctly  irritating  to  surrounding 
tissues,  and  local  inflammatory  troubles  cannot  be  controlled 
until  this  deposit  is  thoroughly  removed. 

6 


DENTAL    MEDICINE. 


Dental  materia  medica  is  an  embodiment  of  the  nature, 
medicinal  properties,  and  therapeutical  action,  of  all  substances 
used  as  medicine  in  dental  practice. 

The  classification  of  medicines  is  made  according  to  their 
action  upon  the  animal  economy. 

The  different  classes  in  common  use  by  dentists  are  as 

follows :  Narcotics  and  hypnotics,  analgesics  or  anodynes, 
anesthetics,  stimulants,  tonics,  sedatives,  antipyretics,  irritants, 
astringents,  styptics,  and  haemostatics,  caustics,  escharotics, 
antizymotics,  or  antiseptics,  and  disinfectants  and  laxatives. 

NAECOTICS  AND  HYPNOTICS. 

Narcotics  (stupor)  are  medicinal  substances  which,  by  im- 
pairing or  destroying  nervous  action,  lessen  the  relationship  of 
the  individual  to  the  external  world.  They  at  first,  however, 
have  a  stimulating  effect,  to  which  their  therapeutic  efficacy  is 
largely  due,  which  is  followed  by  profound  sleep  and  stupor. 
If  the  dose  be  sufficient,  death  will  ensue  by  paralysis  of  the 
centres  of  the  medulla,  which  govern  respiration  and  the  other 
functions  of  organic  life. 

Hypnotics  (sleep)  belong  to  the  class  of  narcotics,  but  are 
capable  of  causing  sleep  without  any  preliminary  cerebral  ex- 
citement, by  bringing  the  brain  into  a  favorable  condition  for  it. 

The  principal  narcotics  are  opium  (see  Anodynes),  alcohol 
(see  Stimulants),  belladonna  (see  Anodynes),  chloroform,  ether 
(see  Anesthetics),  etc. 

The  hypnotics  are  opium,  the  bromides,  chloral,  etc.  When 
administered  to  relieve  pain,  they  are  termed  anodynes. 

74 


NARCOTICS   AND  HYPNOTICS.  75 

Bromine,  Br. — Bromides. 

Derivation. — Bromine  is  obtained  from  sea- water  and  cer- 
tain saline  springs. 

Properties. — Bromine  is  a  dark  brownish-red,  liquid,  non- 
metallic  element.  It  has  an  offensive,  suffocating  odor,  some- 
what resembling  chlorine  and  iodine.  In  its  pure  state  it  is  an 
active  escharotic  and  internally  a  violent  poison.  The  salts  of 
bromine  are  cerebral  and  cardiac  depressants  and  are  highly 
valued  as  hypnotics. 

The  Principal  Preparations: 

Ammonium  Bromide,  NH^Br. — Colorless,  prismatic  crys- 
tal.   Dose,  gr.  v-xx. 

Calcium  Bromide,  CaBr^. — A  white,  granular,  deliques- 
cent salt.     Dose,  gr.  v-3j. 

Lithium  Bromide,  LiBr. — A  white,  granular,  deliques- 
cent salt.     Dose,  gr.  v-xx. 

Potassium  Bromide,  KBr. — Colorless,  cubical  crystals. 
Dose,  gr.  v-3j. 

Sodium  Bromide,  NaBr. — Colorless,  monoclinic  crystals. 
Dose,  gr.  v-3j. 

Zinc  Bromide,  ZnBr^. — A  white,  granular,  deliquescent 
powder.     Dose,  gr.  ss-ij. 

Syrup  of  Bromide  of  Iron. — Contains  10  per  cent,  of  fer- 
rous bromide,  FeBr^.     Dose,  ^ss-j. 

Therapeutic  Uses. — The  bromides  are  used  as  sedatives  to 
the  nervous  system  to  produce  sleep,  and  in  affections  of  the 
heart  or  cerebrum,  when  shown  by  increased  action,  in  neural- 
gia, spasmodic  cough,  etc. 

Dental  Uses. — Bromide  of  potassium  is  a  useful  remedy  in 
convulsions  from  the  irritation  of  dentition,  in  neuralgia,  also 
in  cases  of  extreme  sensitiveness  of  the  soft  palate.  Dose,  gr. 
10-20  every  hour  for  several  hours  before  taking  impression. 


7b  dental  pathology  akd  dental  medicine. 

Chloral,  02110130. 

Derivation. — Ohloral  is  obtained  by  the  action  of  chlorine 
gas  on  absolute  alcohol.  It  is  a  colorless,  unstable,  oily  fluid, 
which  readily  combines  with  water  and  forms  chloral  hydrate, 
the  official  "chloral"  having  the  formula  O2HOI3OH2O. 

Properties  and  Actions. — The  official  body,  chloral  hydrate, 
is  in  the  form  of  a  white,  crystalline  substance,  having  a  pung- 
ent odor  and  taste,  and  is  soluble  in  water,  alcohol,  and 
glycerine. 

It  is  hypnotic,  antispasmodic,  and  to  a  limited  degree 
anesthetic.  It  is  serviceable  in  fevers,  accompanied  by  cere- 
bral excitement,  convulsions,  deliriiim  tremens,  etc.  Dose,  from 
gr.  V  to  gr.  XXX.  Liebreich  claims  to  have  produced  profound 
sleep,  lasting  from  five  to  fifteen  hours,  with  twenty-five  to 
thirty  grains. 

The  hypnotic  action  is  preceded  by  a  stage  of  excitement  of 
short  duration,  which  is  followed  by  sudden  calm  and  refresh- 
ing sleep,  from  which  the  patient  can  be  easily  aroused  to  par- 
take of  nourishment  and  will  readily  fall  asleep  again — differing 
in  this  respect  from  narcotism,  which  is  marked  by  profound 
stupor. 

Dental  Use. — Hydrate  of  chloral  is  sometimes  used  in  den- 
tal practice  for  the  relief  of  odontalgia  from  pulpitis,  from  one- 
half  to  one  grain  being  applied  to  the  inflamed  body.  It  has 
also  been  thought  a  serviceable  agent  by  some  in  the  treatment 
of  putrescent  pulp-canals,  and  as  a  stimulant  and  antiseptic 
injection  in  chronic  alveolar  abscesses. 

ANALGESIOS   OK  ANODYNES. 

Anodynes  are  agents  which  are  capable  of  relieving  pain. 
They  are  divided  into  two  classes,  general  and  local. 

General  anodynes,  when  taken  internally,  affect  the  whole 
organism,  by  depressing  the  cerebral  centers  of  perception  and 
sensation. 


ANALGESICS   OR   ANODYNES.  77 

Local  anodynes,  when  applied,  affect  the  parts  either  by 
impairing:  the  conductivity  of  the  sensory  nerve-fibres,  or  by 
reducing  the  local  circulation.  Some  of  the  most  efficient  ano- 
dynes act  either  general  or  local.  The  principal  agents  of  this 
class  are  as  follows : — 

General  Anodynes. — Opium,  morphia,  belladonna,  aconite, 
ether,  and  chloroform  (see  Anaesthetics). 

Local  Anodynes. — Opium,  belladonna,  carbolic  acid  (see 
Escharotics),  cocaine  (see  Anaesthetics),  aconite,  etc. 

Opium. 

Source. — Opium  is  obtained  from  the  white  poppy,  an  annual 
herb  gTown  in  Asia  Minor. 

Nature. — It  is  a  gummy  exudation  which  follows  the  incis- 
ing of  the  unripe  capsules.  It  should  yield  not  less  than  nine 
per  cent,  of  morphine  when  in  its  normal  moist  condition. 

Opium  contains  seventeen  alkaloids,  the  most  important  of 
these  being  morphine — dose,  gr.  y.,o--!/2 — ^hypnotic,  narcotic,  and 
anodyne. 

Principal  Preparations  of  Opium: — 

Pulvis  opii,  powdered  opium.    Dose,  gr.  Yg-ij. 

Tinctura  opii,  (laudanum),  composed  of  powdered  opium, 
oz.  iiss;  and  diluted  alcohol,  oj  (pint).  Dose,  TTLxij,  or  25  drops, 
equivalent  to  1  gr.  of  opium. 

Tincture  opii  camphor  at  a  (camphorated  tincture  of  opium, 
paregoric)  is  prepared  by  macerating  "sixty  grains  of  opium  in 
two  pints  of  diluted  alcohol,  with  sixty  grains  of  benzoic  acid, 
a  fluidrachm  of  oil  of  anise,  two  ounces  of  clarified  honey,  and 
forty  grains  of  camphor."  Dose,  f3j-fBj.  Dose  for  infant,  v 
to  XX  drops  (gtt.)-Bss.  contains  about  gr.  j.  It  therefore  con- 
tains ^/^Q  the  strength  of  the  tincture. 

Pulvis  ipecacuanhas  et  opii  (Dover's  powder),  composed  of 
ipecac  1  part,  opium  1  part,  sugar  of  milli  8  parts,  triturated  to 
a  fine  powder.     Dose,  gr.  v  to  gr.  xv. 


<0  dextal  pathology  axd  dextal  medicine. 

Belladonna. 
(Deadly  Nightshade.) 

Source  and  Composition. — It  is  an  European  plant,  the 
leaves  and  root  being  the  medicinal  portions.  It  contains  two 
alkaloids — atropine,  the  active  principle,  and  belladonnine. 

Preparations  of  Belladonna.     From  the  leaves: — 

Tincture  of  Belladonna. — Dose,  TTtj-3ss. 

Extract  of  Belladonna. — Dose,  gr.  14-I/2. 

From  the  root : — 

Abstract  of  Belladonna  (powdered). — Dose,  gr.  ys-V2- 

Fluid  Extract  of  Belladonna. — Dose,  nij-v. 

Sulphate  of  Atropine.— Dose,  gr.  Vioo'Veo- 

Therapeutics. — Belladonna  is  especially  useful  in  the  pain 
of  inflammation,  particularly  that  of  rheumatism,  neuralgia, 
etc.,  and  is  used  locally  in  connection  with  morphine  to  relieve 
the  pain  of  abscesses,  boils,  etc. 

Atropine  is  used  by  ophthalmologists  to  lessen  pain,  dilate 
the  pupils,  paralyze  the  accommodation,  etc.  ^ 

Aconite. 

Source  and  Composition. — It  is  obtained  from  the  tuberoas 
root  of  Aconitum  napellus,  a  perennial  plant,  -found  in  the 
mountainous  regions  of  Europe  and  Asia.  The  leaves  are 
sometimes  used,  but  the  root  makes  the  most  powerful  drug. 

The  active  principle  is  the  alkaloid  aconitine,  a  sedative 
poison. 

Principal  preparations : — 

Extract  of  Aconite. — Dose,  gr.  ^2-3- 

Fluid  Extract  of  Aconite. — Dose,  Tn.%=-ij. 

Tincture  Aconite. — Dose,  T^lss-iv. 

Medical  Properties  and  Action. — Aconite  is  a  powerful 
sedative  to  the  nervous  system.  In  large  doses  it  acts  as  a 
cardiac,  respiratory,  and  spinal  depressant. 


ANESTHETICS.  79 

It  proves  fatal  in  poisonous  doses  by  paralyzing  the  heart 
and  respiration.     It  is  also  diaphoretic  and  antipyretic. 

Dental  Therapeutics. — Aconite,  in  the  form  of  a  tincture, 
is  administered  in  inflammatory  affections  and  in  chronic  cases 
of  neuralgia.  It  is  an  active  antagonizer  of  the  fever  process, 
and  has  been  termed  the  "therapeutic  lancet." 

When  applied  locally,  it  checks  inflammation  in  its  first 
stages,  by  paralyzing  the  peripheral  ends  of  the  nerves  in  the 
parts,  and  favoring  rcvsolution;  also  limits  the  extent  of  an 
abscess  where  pus  has  already  formed. 

In  combination  with  the  tincture  of  iodine,  in  equal  parts, 
it  acts  very  promptly  in  the  incipient  stages  of  dental  perios- 
titis, relieving  the  inflammation,  retarding  the  circulation,  and 
stimulating  lymphatic  action. 

In  such  cases  the  gum  over  the  affected  tooth  should  be 
thoroughly  dried  and  then  painted  with  this  combination,  pro- 
tecting the  lip  or  cheek  until  the  remedy  is  absorbed.  It  is  also 
considered  useful  by  many  in  the  dressing  of  pulp  canals,  pre- 
venting the  formation  of  inflammatory  products.  When  applied 
to  a  large  surface,  or  where  the  skin  is  abraded,  care  should  be 
exercised,  or  dangerous  constitutional  effects  may  result. 

The  physiological  antagonists  are  atropine,  morphine, 
digitalis,  and  ammonia.  In  aconite  'poisoning  the  stomach 
should  be  evacuated,  stimulants  administered,  warmth  applied 
to  the  extremities,  and  the  recumbent  position  maintained. 

ANESTHETICS. 

Anesthetics  are  agents  which  temporarily  destroy  sensation 
and  relieve  pain.  They  are  employed  for  this  purpose  during 
surgical  operations,  to  relieve  severe  neuralgia  and  other  pain, 
and  are  sometimes  used  to  relax  the  muscular  system  in  case 
of  spasms.    They  are  divided  into  two  groups :  general  and  local. 

General  anesthetics  are  volatile  substances,  capable  of  pro- 
ducing (when  inhaled)  complete  unconsciousness,  loss  of  sensi- 


80  DENTAL   PATHOLOGY   AND  DENTAL   MEDICINE. 

bility,  and  lessened  motor  power.  When  complete,  general  anes- 
thesia includes  muscular  relaxation. 

Partial  Anesthesia  is  sometimes  employed  where  only  the 
loss  of  conscious  sensation  is  desired.  Here  only  the  cerebrum 
is  controlled;  the  reflex  centers  of  the  spinal  cord  are  still  sen- 
sible. This  is  easily  demonstrated  by  the  muscular  activity 
whenever  a  sensory  nerve  is  irritated. 

'Full  anesthesia,  or  surgical  anesthesia,  is  where  both  the 
cerebral  cortex  and  the  reflex  centers  of  the  spinal  cord  are  para- 
lyzed. Happily  the  centers  of  consciousness  are  first  affected, 
and  those  of  respiration  and  circulation,  which  are  so  essential 
to  life,  last. 

The  accompanying  diagram  from  Long's  Materia  Medica  and 
Therapeutics,  shows  very  clearly  a  division  of  the  central  nerv- 
ous system,  numbered  in  the  order  as  paralyzed  by  anesthetics. 
It  is  now  accepted  that  anesthetics  produce  their  essential  effects 
by  a  direct  action  upon  these  nerve  centers. 

Stages  of  anesthesia  may  be  divided  into  the  following  four 
distinct  divisions: 

(1)  Stimulation. 

(2)  Primary  anesthesia. 

(3)  Full  anesthesia. 

(4)  Paralysis. 

The  phenomena  of  each  stage  follow  each  other  in  apparent 
sequence  and  are  readily  distinguished.  The  most  significant 
associated  with  the  first  stage  is  general  functional  excitation. 
The  early  action  upon  the  cerebrum  producing  disturbed  nerve 
function,  such  as  laughing  or  crying,  incoherent  talking,  un- 
controlled muscular  movements,  holding  the  breath,  etc. 

The  second  stage  or  primary  anesthesia  is  manifest  by  the 
abolition  of  conscious  sensation  of  pain,  though  there  may  be 
marked  reflex  irritability,  and  respiration  may  be  interrupted 
by  spasms  or  rigidity  of  the  respiratory  muscles.  Surgical 
operations  should  not  be  undertaken  during  this  stage  owing  to 
the  dangers  of  reflex  impressions  upon  the  vital  ganglia. 


AKESTHETICS. 


81 


Danger  area 


Anaesthesia  area 

1.  Conseiouanesa  aboliahed 


8.  Reapiration  paralyzed 


4.  Circulation  paralyzed 


The  several  sections  are  numbered  in  the 
order  in  which  they  are  paralyzed  by  anes^ 
thetics.  The  paralysis  of  1  and  2  constitutes 
surgical  anesthesia,  paralysis  of  3  introduces 
an  element  of  great  danger,  and  that  of  4  is 
usually  fatal. 

[The  heart  is  included  in  this  diagram  of 
the  several  parts  of  the  central  nervous  sys- 
tem, for  the  reason  that  it  contains  nerve- 
ganglia,  which,  with  their  highly  irritable 
muscular  structure,  provides  for  its  auto- 
matic, rhythmic  action.  This  provision  is' 
quite  independent  of  the  cerebrospinal  sys- 
tem.] 


2.  Be  flex  activity  aboliahed 


Fig,  2><. 


82  DENTAL    PATHOLOGY   AND  DENTAL    MEDICINE. 

Full  anesthesia,  profound,  or  surgical  anesthesia  as  one 
may  choose  to  term  it,  is  marked  by  complete  relaxation  of  the 
muscular  system,  and  an  absence  of  reflex  irritability  which  is 
usually  tested  by  touching  the  cornea  or  conjunctiva  of  the 
eye.  With  muscular  relaxation  full  and  regular  respiration  fol- 
lows, accompanied  by  stertor  or  snoring  largely  due  to  vibra- 
tions of  the  relaxed  soft  palate. 

The  fourth  or  paralytic  stage  should  always  be  guarded 
against.  It  is  the  danger  ground  and  may  result  in  paralysis 
of  the  heart  or  respiration. 

The  principal  general  anesthetics  are  ether,  chloroform, 
nitrous  oxide  gas,  and  bromide  of  ethyl. 

Local  anesthetics  are  agents  whose  action  is  limited  to  the 
circumscribed  parts  to  which  they  ar^  applied.  They  paralyze 
the  nerves  of  the  part,  thus  temporarily  destroying  sensation. 
They  act  similarly  to  the  local  anodynes,  except  that  while  the 
anodynes  diminish  the  sensibility  of  the  parts,  the  local  anes- 
thetic destroys  sensation  entirely  for  a  time. 

The  principal  agents  of  this  class  are  cocaine,  eucaine, 
ethyl  chloride,  and  absolute  ether. 

Ether^  C^HjqO. 

Derivation. — Sulphuric  ether  (improperly  so  called)  is 
ethylic  ether,  or  oxide  of  ethyl.  It  is  obtained  "by  the  distilla- 
tion of  ethylic  alcohol  and  sulphuric  acid,  the  acid  dehydrating 
the  alcohol  and  remaining  in  the  retort.  (C^IIgO)^ — 11,0= 
C,H,„0. 

Medicinal  Properties  and  Actions. — Ether  is  a  colorless, 
volatile,  and  inflammable  liquid.  It  is  an  anesthetic  and  ano- 
dyne, a  diffusible  stimulant,  and  a  narcotic  poison.  Adminis- 
tered internally,  it  is  one  of  the  most  powerful  secretion  stimu- 
lants known.  The  action  of  the  heart,  and  hence  the  circulation 
is  increased,  flushing  and  warmth  of  the  surface  soon  follow. 
The  senses  are  tnore  keen,  and  the  phenomenon  of  alcoholic  in- 


ANESTHETICS.  83 

toxication  results,  which  is  less  protracted,  however,  ether  being 
quickly  eliminated,  chiefly  by  the  lungs. 

The  first  effect  of  ether,  that  is  the  increase  in  arterial  pres- 
sure due  to  heart  and  vaso-motor  stimulation,  is  soon  followed 
by  a  fall  in  blood  pressure  and  lowering  in  force  and  frequency 
of  the  heart  movements. 

Principal  Preparations: — 

Ether  Fortior,  stronger  ether,  ethyl  oxide,  "C^H^^O,"  con- 
tains about  six  per  cent,  of  alcohol. 

Sulphuric  Ether,  ethyl  sulphate,  C^H^^SO^. 

Nitrous  Ether,  ethyl  nitrite  (sweet  spirit  of  nitre), 
C.,E[.!IsrO,.  The  well-known  antipyretic  and  diaphoretic.  Dose, 
TUv-3ij. 

Dental  Use.— Ether  is  employed  as  a  general  and  local 
anesthetic,  as  a  local  anodyne  in  neuralgia  and  odontalgia,  and 
as  a  counter-irritant,  evaporation  being  prevented. 

Ether  as  an  Anesthetic  Agent. — The  practicability  of 
producing  anesthesia  by  the  inhalation  of  ether  was  first 
demonstrated  by  Dr.  Horace  Wells,  of  Hartford,  Conn.,  and 
Dr.  W.  G.  S.  Morton,  of  Boston,  Mass.,  during  the  years 
1844-'46. 

Ether,  though  less  prompt  in  its  action,  is  much  safer  than 
chloroform.  It  has  its  necrology,  however ;  a  number  of  fatal 
cases  (about  thirty)  have  been  reported. 

The  Administration  of  Ether. — The  operator  should  be 
well  assured,  before  administering  an  anesthetic,  that  the  pa- 
tient is  not  laboring  under  any  serious  disease  of  the  heart, 
brain,  or  lungs,  as  ignorance  in  this  direction  might  lead  to 
fatal  results.  The  clothing  about  the  neck  and  chest  should 
always  be  loose,  lest  it  act  as  an  impediment  to  respiration,  and 
if  artificial  teeth  be  worn,  they  should  be  removed  before  the 
administration  of  the  anesthetic. 

For  the  inhalation  of  ether  and  chloroform  a  number 
of  instruments  have  been  devised,  but  the  simplest  and  probably 


84  DENTAL   PATHOLOGY  AND  DENTAL   MEDICINE. 

the  best  method  is  from  a  sponge,  napkin,  or  handkerchief, 
placed  within  a  cone,  formed  of  a  towel  or  stiff  paper,  with  a 
small  opening  at  the  apex  for  the  admission  of  air;  or  a  small 
piece  of  lint  can  be  held  in  the  palm  of  the  hand  and  on  these 
pour  the  anesthetic  agent. 

The  inhalation  should  be  commenced  cantionsly,  the  pa- 
tient should  be  directed  to  breathe  quite  naturally,  and  to  obey 
any  instructions  given,  as  the  rasing  of  the  hand,  etc.  The 
towel  or  napkin  should  be  held  six  inches  from  the  patient's 
face,  aproaching  it  gradually,  thus  overcoming  the  irritating 
effect  and  a  sense  of  strangulation,  which  follow  when  the  agent 
is  placed  at  once  to  the  mouth  and  nostrils. 

Action  of  Ether. — The  first  stage  of  anesthesia  is  stimulant, 
the  second  is  tetanic  or  convulsive,  the  third,  complete  relax- 
ation. 

During  complete  anesthesia  the  face  is  cool,  there  being 
a  profuse  perspiration;  the  eyes  are  closed,  insensible  to  the 
touch,  and  the  pupils  are  somewhat  contracted.  The  respiration 
and  pulse  are  somewhat  slower  than  normal,  as  shown  in  the 
following  table : — 

Normal  pulse,  72  a  minute. 

Pulse  on  administration  of  ether: — 

1st  min.         2d  min.         3d  min.         4th  min.         5th  min. 
92  109  110  94  69 

Normal    respiratory    movements    average    about    20    a 
minute. 
Respiration  on  administration  of  ether: — 

1st  min.         2d  min.         3d  min.         4th  min.         5th  min. 
23  24  26  18  15 

Order   in  Which   Nerve   Centers   Are   Acted   Upon.— 

First,  the  cerebrum;  second,  cerebellum;  third,  the  spinal  cord, 
fourth,  the  medulla  oblongata. 


ANESTHETICS.  85 

The  Quantity  o£  Ether  Required. — Largest  quantity,  9 
ozs. ;  minimum,  2^2  ozs. ;  average  quantity  to  produce 
anesthesia,  5  ozs. 

The  Time  Required  for  Full  Anesthesia. — Longest  time 
required,  24  minutes;  shortest  time,  S^/^  minutes;  average 
time,  8  minutes. 

The  Dangers  of  Anesthesia. — There  are  conditions  ren- 
dering general  anesthesia  dangerous,  and  the  practitioner, 
whether  medical  or  dental,  should  be  well  assured,  before  ad- 
ministering ether  or  chloroform,  that  none  of  these  are  present. 
They  are  fatty  degeneration  of  the  heart,  valvular  lesions,  kid- 
ney disease,  brain  tumors,  respiratory  obstructions  from  en- 
larged tonsils,  thoracic  tumors  or  aneurism,  and  chronic  alco- 
holism. It  should  be  born  in  mind  that  ether  is  irritant  to  the 
air  passages  and  kidneys,  lessening  the  elimination  power  of 
the  latter.  An  anesthetic  should  never  be  administered  on  a 
full  stomach,  as  sickness  would  likely  follow  that  would  inter- 
fere with  the  operation,  and  anesthesia  of  the  glottis  prevents 
the  expulsion  of  vomited  matter  in  case  it  enters  the  larynx  by 
regurgitation;  neither  should  it  be  given  after  long  fasting,  as 
an  absence  of  nutrition  would  tend  toward  cardiac  paralysis; 
excitement  should  be  avoided,  instruments  should  be  kept  out 
of  sight,  and  too  many  spectators  should  not  be  present.  A 
painful  operation  should  not  be  commenced  before  the  stage  of 
complete  anesthesia  is  reached,  or  it  may  cause  death  from 
shock,  as  the  result  of  peripheral  irritation. 

Treatment  of  Dangerous  Symptoms. — In  case  of  the  sus- 
pension of  the  heart's  action,  the  agent  should  be  withdrawn, 
the  body  placed  in  a  reclining  position,  and,  if  need  be,  inverted, 
and  air  freely  admitted.  The  failure  of  respiration  requires  the 
drawing  forward  of  the  tongue,  by  a  finger  being  thrust  deeply 
into  the  mouth;  the  inhalation  of  a  good  stimulant,  nitrite  of 
amyl,  gtt.  ij  to  gtt.  v;  but  care  is  necessary  in  its  use,  and  not 
jnore  than  two  or  three  drops  should  be  administered  to  patients 


86  DENTAL   PATHOLOGY   AND  DENTAL    MEDICINE. 

who  have  never  inhaled  it.  The  inhalation  of  ammonia  is  pos- 
sibly as  efficient,  and  can  be  used  with  more  freedom  than  nitrite 
of  amyl.  Galvanism,  too,  has  been  successfully  employed  as  a 
cardiac  and  respiratory  stimulant,  "the  positive  pole  being; 
placed  to  the  nostril  and  the  negative  pole  over  the  diaphragm, 
to  excite  a  reflex  action  between  the  fifth  pair  and  the  pneumo- 
gastric,  or  the  poles  may  be  applied  directly  over  both  phrenic 
nerves,  or  on  a  line  with  the  fourth  cervical  vertebra,  in  order 
to  stimulate  respirations;  or  one  pole  may  be  placed  over  the 
upper  dorsal  spinous  process  and  the  other  pole  over  the  apex 
of  the  heart,  to  induce  cardiac  contraction."*  And  if  necessary, 
artificial  respiration  should  be  employed  (see  Appendix)  and 
warmth  applied.  The  extremities  should  also  be  rubbed  briskly, 
rubbing  upward. 

Note. — It  should  be  remembered  that  ether  vapor  is  heavier 
than  air,  and  forms  therewith  a  highly  explosive  mixture. 
Therefore,  if  a  light  must  be  in  the  room,  it  should  be  high 
above  the  patient.  A  grate  fire,  gas  stove,  etc.,  in  the  vicinity 
are  very  dangerous. 

CHLOROFORM;,    CHCI3. 

Derivation. — Chloroform  (Ter-chloride  of  Methyl,  or  Meth- 
ylic  Ether)  is  obtained  by  distilling  alcohol  with  chlorinated 
lime.  It  was  discovered  in  1831,  by  Samuel  Guthrie,  of  Sack- 
ett's  Harbor,  N.  Y. 

The  form  for  medicinal  use  is  Chloroformum  Purificatum, 
or  Purified  Chloroform. 

Medicinal  Properties  and  Action. — When  inhaled,  chloro- 
form is  an  anesthetic,  and  when  administered  internally,  it  is 
an  anodyne  and  antispasmodic.  If  swallowed  undiluted,  it 
excites  great  inflammation  of  the  mucous  membrane  and  causes 
violent  gastritis. 


*Gorgas'    "Dental   Medicine." 


ANESTHETICS.  87 

Its  effects  are  similar  to  those  of  ether,  but  more  rapidly 
produced,  and  it  is  more  powerful  in  its  action;  hence  requiring 
more  care  in  its  administration. 

When  first  administered  (internally)  it  causes  a  feeling  of 
warmth  in  the  stomach,  which  is  soon  followed  by  a  sense  of 
coldness.  It  increases  the  action  of  the  heart,  producing  excite- 
ment of  the  brain,  followed  by  depression  and  deep,  heavy  sleep. 
In  large  doses  it  causes  stupor  and  insensibility,  and  has  caused 
death. 

Therapeutic  Uses. — Chloroform  is  used  for  the  same  pur- 
poses as  is  ether,  and  is  much  employed  locally  in  liniments. 
Administered  by  inhalation,  it  is  a  general  anesthetic,  and 
when  administered  internally,  in  substance,  it  is  an  anodyne 
and  antispasmodic,  and  is  used  as  such  in  cases  of  nausea,  sea 
sickness,  sick  headache,  and  in  cases  of  cholera.  In  the  last 
named  it  has  probably  proven  more  efficacious  than  any  other 
single  remedy.     Dose,  nij-^ss,  diluted,  internally. 

Spirit  of  chloroform  (chloroform,  Bj;  diluted  alcohol,  Sij), 
3ss-3j. 

For  inhalation,  ^j-Bj.    Average,  3iij. 

Dental  Use. — Chloroform  is  employed  by  some  in  dental 
practice  as  a  general  anesthetic;  its  use,  however,  is  growing 
less  every  year,  in  favor  of  ether  and  nitrous  oxide  gas.  It  is 
also  used  as  a  local  anesthetic;  in  this  case  it  is  generally  com- 
bined with  other  substances,  as  aconite,  alcohol,  ether, 
opium,  etc. 

For  administration  as  an  anesthetic,  treatment  of  dan- 
gerous symptoms,  etc.,  see  Ether.  ® 

Chloroform  Narcosis. — 

Shortest   time, 2  minutes  30  seconds. 

Longest  time, 14         "        30         " 

Average    time,         6         "24         " 

Chloroform  mortality  is  1  in  3,000;  over  500  fatal  cases 
are  reported,  none  of  which,  however,  were  in  obstetrical  prac- 
tice.    The  apparent  safety  of  chloroform  in  obstetrics  has  been 


88 


DENTAL   PATHOLOGY  AND  DENTAL    MEDICINE. 


explained  by  the  theory  that  death  from  chloroforra  is  due  to 
vasomotor  paralysis,  and  as  pregnancy  increases  the  vasomotor 
tension,  pregnant  women  are  in  consequence  less  liable  to  fatal 
results. 

Compared  with  ether  mortality,  1  in  16,000. 

The  physiologic  action  of  ether  and  chloroform  compared 
is  as  follows : 


Organs,      Tissues, 
etc.,  affected. 

Arterial  tension  ( 
and  blood-pres-  < 
sure,    ( 


Heart, 


Lung-s, 


Mouth,     ncse     and 
pharynx,    


Stomach     and     in-    r 
testines,  I 


Liver, 


i 


Kidneys, 


Temperature, 


Pupils   and   corneal    f 
reflex, ' 


Ether. 

Greatly    increases    both. 
Followed  by  fall. 


Stimulates      and  large 

doses  paralyze.  Zone 

between     these  quite 
large. 

Has  slightl.v  direct  ir- 
ritating effect,  caus- 
ing increased  tracheo- 
bronchial secretion. 
Stimulates  respiratory 
center  and  large  doses 
paralyze.  Zone  very 
large. 

Greatl.T  increases  all  se- 
cretions, f^arge  doses 
paralyze  muscles  of 
tongue,  epiglottis  and 
palate.  Both  above 
favor    aspiration. 


Considerable  nausea   and  ^ 
vomiting.  I 


No    effect. 


In    normal    kidneys  ] 

transitory    effect  | 
(casts    and    traces    of 

albumin).         decreased  | 

amount    of    bio  d    and  ) 

secretion.     In   diseased  i 

kidneys   has  a   bad  ef-  I 

feet,    may    cause    anu-  ! 

ria   and  uremia.  J 

Lowers   it. 

Pupils    contracted    some  "] 
and    respond.      Corneal 
reflex  of  some  value. 


Chloroform. 
Gradually   decreases    both. 


Depresses  and  large  doses 
paralyze ;  zone  between 
these  two,    small. 


Slows  respiration  and 
large  doses  paralyze. 
Zone   small. 


Scarcely  any  effect  on  se- 
cretions. Large  doses 
also  paralyze  tongue, 
etc. 


Less  nausea  than  ether;  in 
large  doses  causes  some 
fatty  degeneration  of 
muscles. 

Prolonged  administration 
causes  fatty  degenera- 
tion with  decreased  gly- 
cogen, icterus,  and  in 
fatty  liver  may  cause 
acute   yellow   atrophy. 

In  ordinary  administra- 
tion and  normal  kidneys 
but  slight  transitory  ef- 
fect. In  prolonged  ad- 
ministration causes  con- 
siderable fatt.v  degen- 
eraiion. 


Lowers  it  less  than  ether. 

Pupils  somewhat  con- 
tracted but  respond.  Sec- 
ondary dilation  of  pupil, 
bad  sign.  Corneal  re- 
flex of  li**!*  vnlnp. 


ANESTHETICS.  89 

Nitrous  Oxide  Gas,  NgO. 

History. — Nitrous  Oxide,  or  "Laughing"  Gas,  was  discovered 
by  Dr.  Priestly  in  1776,  and  its  respirability  demonstrated  by 
Sir  Humphry  Davy,  though  the  results  v^ere  not  published  until 
some  twenty  years  afterward.  In  1844  Dr.  Horace  Wells  prac- 
tically demonstrated  the  value  of  its  anesthetic  property  for  the 
relief  of  pain  during  surgical  or  dental  operations. 

Nitrous  oxide  gas  is  manufactured  by  slowly  melting  and 
boiling  the  salt  nitrate  of  ammonia  in  a  glass  retort,  dissolving 
it  into  a  vapor  of  water  and  a  permanent  gas  (NH^NOg+Heat 
=N20+2H20).  The  gas  should  pass  through  three  wash 
bottles,  the  first  containing  a  solution  of  the  sulphate  of  iron  or 
caustic  potash,  and  the  other  two  pure  water,  for  the  purpose  of 
purifying  it  before  it  enters  the  receiver,  from  which  it  is 
administered  to  the  patient  through  an  inhaling  tube.  A 
pound  of  the  salt  will  generate  about  thirty  gallons  of  the  gas. 
It  is  perfectly  fused  at  226°  F.,  white  fumes  are  emitted  at 
302°  F.,  and  gas  begins  to  evolve  at  460°  F.  If  the  temperature 
is  raised  to  500°  F.,  a  dangerous  impurity,  nitric  oxide,  is  given 
off;  this  need  not  be  generated,  however,  if  the  proper  care  is 
observed,  not  allowing  the  temperature  to  rise  above  480°  F. 

Liquefied  Nitrous  Oxide. — The  most  convenient  form  for 
use  is  the  liquefied  gas,  it  being  liquefied  and  solidified  under 
intense  cold  and  great  pressure.  It  is  then  secured  in  strong 
iron  cylinders,  from  which  it  is  allowed  to  escape  into  an  in- 
haling bag  when  needed  for  use. 

The  advantages  of  this  form  of  gas  are  its  purity,  con- 
venience for  use,  the  large  supply  which  can  be  kept  on  hand, 
and  its  comparative  freedom  from  deterioration,  notwithstand- 
ing its  age. 

Properties  and  Actions. — ^Nitrous  oxide  gas  is  an  elastic, 

colorless  gas,  with  a  very  slight  and  agreeable  odor.     It  will 

freeze  into  a  beautiful,  clear,  crystalline  solid,  at  about  15°  F. 

below  zero. 
7 


90  DENTAL    PATHOLOGY   AND  DENTAL    MEDICINE. 

"By  the  evaporation  of  this  solid,  a  degree  of  cold  may  be 
produced  far  below  that  of  carbonic  acid  bath  in  vacuo,  or 
lower  than  17°  F."'^" 

Nitrous  oxide  gas  supports  combustion  with  nearly  the  same 
promptness  as  oxygen. 

As  an  Anesthetic. — Nitrous  oxide  gas  is  the  most  pleasant 
and  the  safest  general  anesthetic  known.  The  shortness  of  the 
anesthetic  stage  is  the  greatest  objection  to  its  administration 
for  surgical  operations,  though  its  rapid  action,  comparative 
safety,  and  the  transient  nature  of  its  effects  on  the  system 
render  it  the  most  useful  anesthetic  agent  for  all  minor  opera- 
tions, such  as  the  extracting  of  teeth,  removal  of  nerves  from 
the  teeth,  where  the  tooth  substance  is  lost  to  such  an  extent 
that  a  devitalizing  agent  could  not  be  retained,  for  the  lancing 
of  abscesses,  etc. 

The  administration  of  nitrous  oxide  gas  for  dental  oper- 
ations, should  be  conducted  with  the  same  care  that  is  given 
to  ether  and  chloroform,  though  it  is  a  comparatively  safe 
anesthetic.  The  patient  should  be  seated  in  an  operating  chair 
which  will  admit  of  the  back  being  lowered  to  such  a  degree 
that  the  patient  could  at  once  be  placed  in  a  horizontal  position. 
The  dress  about  the  throat  and  waist,  if  tight,  should  be  previ- 
ously loosened,  and  the  patient  should  not  have  partaken  of  food 
for  at  least  two  hours  previous  to  the  inlialation  of  the  gas. 

A  mouth  prop,  of  which  there  are  several  patterns  manu- 
factured, should  he  placed  between  the  teeth,  to  prevent  the 
closure  of  the  jaws,  as  the  muscles  become  rigidly  contracted 
during  the  administration  of  this  gas.  The  most  suitable  prop 
is  one  made  of  India  rubber — the  ordinary  lead-pencil  eraser, 
cut  in  proper  lengths,  answers  the  purpose  very  nicely — or  a 
firm  cork,  as  it  prevents  injury  to  the  teeth  or  fillings,  which 
sometimes  occurs  when  a  mouth  prop  of  a  hard  substance  is 

*Gorgas'   "Dental  Medicine." 


AXESTHETICS.  91 

used.  The  patient  is  then  directed  to  take  full,  regular,  and 
deep  inspirations  of  the  gas,  the  nose  being  held  or  covered, 
to  prevent  the  admixture  of  atmospheric  air.  Its  anesthetic 
effects  are  soon  made  manifest  by  strong,  involuntary  respira- 
tions, accompanied  by  snoring,  this  being  caused  by  the  relax- 
ation of  the  nuiscles  of  the  pharynx,  and  paralysis  of  the  tongue, 
causing  it  to  fall  back  toward  the  throat,  interfering  with 
breathing,  and  a  livid  appearance  of  the  lips,  cheeks,  and  finger 
nails,  due  to  the  discolored  blood  in  the  capillaries.  Bu1  the 
most  delicate  test  for  complete  anesthesia  is,  as  in  ether  and 
chloroform,  the  loss  of  sensibility  to  the  touch  in  the  conjunctiva 
of  the  eye. 

The  amount  of  gas  required  to  produce  complete  anesthesia 
varies,  from  five  to  fifteen  gallons  being  the  usual  amount.  Out 
of  several  administrations  the  writer  has  had  one  case  where  65 
gallons  were  required,  and  another  where  SO  gallons  were  in- 
haled before  the  anesthetic  stage  was  reached. 

The  first  stage  under  nitrous  oxide  gas  is  muscular  activity. 

The  second  stage  is  muscular  rigidity.  It  can  not  be  con- 
tinued until  complete  muscular  relaxation,  lest  the  patient  die 
of-  asphyxia. 

Nitrous  Oxide  Gas  Mortality. — There  is  about  one  death 
to  each  125,000  administrations. 

Dangerous  Symptoms,  with  Treatment,  etc. — See  Ether. 

Bromide  of  Ethyl^  C^H^Br. 

Derivation. — Bromide  of  ethyl,  or  hydrobromic  ether,  is 
obtained  by  distilling  bromide  of  potassium  and  sulphuric  ether, 
and  redistilling  with  chloride  of  lime. 

Properties. — It  is  a  colorless,  volatile  fluid,  possessing  an 
agreeable  ethereal  odor  and  a  pungent  taste.  It  is  not  inflam- 
mable, caustic,  nor  irritant;  in  this  respect  it  is  preferable  to 
chloroform  or  ether  as  an  anesthetic  agent. 

The  Administration. — Bromide  of  ethyl  is  administered  as 
is  ether  or  chloroform,  or  in  a  folded  starched  napkin,  so  as  to 


92  DENTAL   PATHOLOGY   AXD  DENTAL    MEDICINE. 

cover  the  face,  as  directed  by  Prof.  Gorgas.  A  soft  linen  hand- 
kerchief is  placed  inside  the  napkin,  and  upon  this  the  agent  is 
poured;  one  drachm  should  be  used  at  first,  directing  the  pa- 
tient to  take  deep,  full  inspirations.  At  the  end  of  two  minutes 
the  second  drachm  should  be  added;  this  should  be  repeated  at 
intervals  of  two  minutes,  until  complete  anesthesia  is  produced. 
The  quantity  differs  according  to  the  susceptibility  of  the 
patient. 

Action. — The  administration  of  bromide  of  ethyl  is  attended 
with  some  danger,  and  clinical  experience  has  not  demonstrated 
to  careful  operators  that  it  is  as  safe  as  some  other  and  older 
agents  of  this  class.  It  has  a  toxic  action  on  the  centers  of 
respiration.  The  heart  force  is  decreased  and  its  action  is  more 
frequent,  which  contributes  to  the  paralysis  of  the  respiratory 
centers.  Several  deaths  occurred  in  a  very  limited  number  of 
administrations  of  this  agent. 

Precautionary  measures  in  administering  anesthetics: 
That  respiration  may  in  no  way  be  hampered,  the  operator 
should  see  to  it  that  the  respiratory  tract  is  not  encroached 
upon  either  by  a  collar  at  the  throat,  or  by  corset  stays  about  the 
chest.  It  is  quite  as  important  to  test  the  freedom  of  respira- 
tion before  administering  an  anesthetic  as  it  is  to  take  the 
pulse  or  listen  to  the  heart's  action.  Where  enlarged  tonsils  are 
noted  and  post-nasal  growths  indicated  or  enlargement  of  the 
glands  of  the  neck,  goitre,  severe  bronchitis  or  any  other  local 
trouble  which  might  interfere  with  respiration,  or  where  there 
is  apparent  existence  of  serious  disease  of  the  vital  organs,  as 
indicated  under  the  dangers  of  anesthesia,  a  general  anesthetic 
should  not  be  administered  without  consulting  the  family  physi- 
cian, and  possibly  securing  his  co-operation. 

The  neurotic  patient  may  be  at  first  misleading.  Mental  dis- 
quietude frequently  causes  an  accelerated  action  of  the  heart, 
or  such  a  patient  may  at  first  hold  the  breath  or  breathe  ap- 
parently with  much  effort.  These  should  be  noted  and  not  ac- 
cepted as  normal  conditions. 


ANESTHETICS.  93 

Some  operators  prefer  the  admixture  of  ether  and  chloroform, 
or  alcohol,  ether  and  chloroform,  while  others  adhere  strictly  to 
the  separate  drug;  and  claim  that  the  various  mixtures  are  to 
be  depreciated  owing  to  the  uncertainty  as  to  the  exact  propor- 
tion of  the  separate  ingredients  the  patient  would  appropriate. 

Cocaine. 

Source. — Cocaine  is  the  active  crystalline  alkaloid  of  Ery- 
throxylon  coca,  a  small  Peruvian  shrub.  The  leaves  resemble 
those  of  Chinese  tea,  and  in  South  America  thy  are  used  by 
eight  millions  of  people  much  as  we  use  tea  or  coffee. 

In  the  preparation  of  the  alkaloid,  it  is  necessary  that  the 
leaves  be  carefully  gathered,  as  the  best  quality  only  should  be 
used.  They  should  be  dried,  and  not  injured  by  age  or  exposure 
to  the  air,  as  moisture  deprives  them  of  value. 

Preparations  of  Erythroxylon : — 

Extractum  Erythroxyli  Fluidum,  fluid  extract  of  ery- 
throxylon.   Dose,  3ss-ij. 

Salts  of  cocaine. 

Cocaine  Hydrochlorate,  C^_H2iN0^. — Dose  internally,  gr. 
Vg-ij ;  most  commonly  used  as  a  local  anesthetic  in  aqueous  so- 
lutions, 2-5  per  cent. 

Cocaine  Oleate,  cocaine  and  oleic  acid,  5-20  per  cent,  solu- 
tions for  external  use. 

Cocaine  Hydrobromate,  cocaine  and  hydrobromic  acid, 
2-10  per  cent,  as  a  local  anesthetic. 

Cocaine  Wines,  Pastes,  Lozenges,  etc.,  are  made  in  great 
varieties. 

Medicinal  Properties  and  Action. — Cocaine,  when  applied 
locally,  acts  as  an  anesthetic ;  when  taken  internally  in  small 
doses,  it  is  a  general  stimulant,  improving  digestion,  stimulating 
the  respiration,  circulation,  etc.  It  produces  wakefulness  and  a 
marked  diminution  of  the  sense  of  fatigue  and  hunger.,     ^ov 


94  DENTAL   PATHOLOGY  AND  DEKTAL    MEDICINE. 

this  reason  the  leaves  are  chewed  by  the  Peruvian  Indians  to 
sustain  them  during  long  journeys  or  arduous  labor. 

A  toxic  dose,  or  long-continued  use  (cocaine  habit)  pro- 
duces insomnia,  decay  of  the  moral  and  intellectual  powers, 
hallucinations,  insanity,  and  death. 

Dental  Use. — The  salts  of  cocaine  have  proven  very  efficient 
for  their  local  anesthetic  and  anodyne  effects;  their  power  as  a 
local  anesthetic  is  very  great  over  a  limited  area,  and  hence  it 
is  of  special  value  to  the  dentist,  for  operations  upon  the  sub- 
mucous tissues  and  the  extraction  of  teeth,  where  it  should  be 
used  by  hypodermic  injection,  or  applied  to  the  gum  on  either 
side  of  the  tooth  to  be  extracted^  the  latter  method  being  the 
safer;  two  or  three  applications  should  be  made  at  intervals  of 
about  two  minutes  each,  when  a  painless  operation  is  generally 
secured.  It  has  been  found  to  act  very  happily,  also,  in  connec- 
tion with  arsenious  acid,  for  the  devitalization  of  dental  pulps, 
the  pulp  dying  without  giving  the  patient  any  discomfort.  But 
as  for  its  use  as  a  pain  obtundent  in  hypersensitive  dentine,  its 
practical  benefits  are  questionable. 

A  warning,  however,  should  be  given,  that  a  potency  for 
evil  lurks  in  this  most  valuable  drug.  In  many  cases  where  it 
has  been  injected  into  the  gum  tissue  for  extraction  of  teeth, 
toxic  results  of  an  alarming  nature  have  occurred  and  patients 
have  been  rendered  ill  for  several  weeks.  This,  however,  is  not 
apt  to  follow  when  the  patient  is  of  a  sanguine  temperament  and 
in  good  health.  The  writer  has  made  a  record  of  many  cases 
where  toxic  results  have  followed  the  use  of  this  drug,  and  finds 
them  all  to  be  of  a  nervous  or  hysterical  temperament,  or  preg- 
nant women.  The  lesson  is  that  we  should  use  judgment  and 
discrimination  in  its  application. 

Dangerous  Symptoms. — The  extremities  usually  become 
cold  and  rigid,  the  eyes  staring  and  glassy,  and  the  face  pallid, 
while  the  pulse  is  weak,  the  heart  beats  faint,  and  respiration 
slow  and  weak — the  symptoms  of  an  impending  collapse. 


ANESTHETICS.  95 

Treatment  of  Dangerous  Symptoms. — Fresh  air  should 
be  admitted  and  some  good  stimulant  administered,  such  as 
brandy,  or  aromatic  ammonia  and  nitrate  of  amyl — ^by  inhala- 
tion, or  ether  in  case  of  convulsions,  and  if  need  be  the  battery. 
As  soon  as  the  patient  is  able,  assist  him  to  stand  up  and 
promenade. 

Chloride  of  Ethyl,  C^HgCl. 

Properties. — Chloride  of  ethyl  is  a  colorless  liquid  possessing 
a  strong  ethereal  odor,  and  is  very  volatile  and  inflammable  in 
ordinary  temperature.  Its  boiling  point  is  about  50°  F.  It  is 
due  to  this  low  boiling  or  vaporizing  point  that  it  is  so  exactly 
adapted  to  the  special  requirements  of  a  local  anesthetic.  It  is 
put  up  in  convenient  glass  tubes,  drawn  out  to  a  fine  point,  and 
hermetically  sealed. 

The  point  of  the  tube  is  marked  by  a  file  scratch  at  its 
smallest  part.  Hero  the  point  is  broken  off  when  ready  for  use, 
either  by  the  fingers  or  the  forceps.  Immediately  the  chloride 
in  a  gaseous  state  escapes  from  the  small  opening,  and  if  the 
tube  is  partially  inverted,  a  small  jet  of  the  liquid  is  projected; 
this  is  further  accelerated  by  allowing  a  good  portion  of  the 
tube  to  come  in  contact  with  the  hand,  the  warmth  of  which 
hastens  the  vaporization  of  the  liquid. 

The  preparation  of  chloride  of  ethyl,  as  spoken  of  above  (in 
glass  tubes),  is  a  patented  process.  As  the  chloride  evaporates 
in  ordinary  temperature  and  is  very  inflammable,  the  point  has 
to  be  drawn  out  and  sealed  while  the  tube  and  its  contents  are 
immersed  in  ice  water. 

The  Application  and  Action. — ^When  about  to  apply,  the 
parts  to  be  anesthetized  should  be  thoroughly  dried,  by  means 
of  absorbent  cotton  or  napkin,  then  the  point  of  the  tube  should 
be  broken,  or  the  screw-cap  removed  as  the  case  may  be,  as  pre- 
viously directed,  and  the  fine  jet  of  chloride  directed  upon  the 
surface. 


96  DENTAL   PATHOLOGY  AND  DENTAL    MEDICINE. 

If  teeth  are  to  be  extracted,  a  napkin  should  be  placed  in  the 
mouth  back  of  the  teeth  to  be  operated  upon,  and  the  patient 
directed  to  breathe  entirely  through  the  nose;  the  liquid  should 
then  be  projected  upon  the  mucous  membrane  around  the  tooth 
or  root  and  upon  the  cheek  over  the  track  of  the  inferior  maxil- 
lary nerve  for  the  lower,  and  on  the  temple  over  the  emergence 
of  the  fifth  nerve  for  the  upper  teeth.  This  application  upon 
the  face,  however,  need  not  be  made  unless  the  teeth  are  very 
difficult  to  extract,  and  prolonged  anesthesia  is  desired. 

It  is  seldom  necessary  to  use  the  entire  contents  of  a  tube 
for  a  single  operation;  one-quarter  of  it  will  usually  produce 
complete  anesthesia  of  the  parts.  The  opening  in  the  tube  can 
then  be  closed  and  the  contents  preserved  for  a  subsequent 
operation. 

The  writer  has  employed  chloride  of  ethyl  in  over  three  hun- 
dred minor  surgical  operations  with  uniform  success.  It  is 
a  most  satisfactory  local  anesthetic  in  the  extraction  of  teeth, 
lancing  of  abscesses,  removal  of  small  tumors,  opening  the 
maxillary  sinus,  extraction  of  the  tooth  pulp,  and  in  the  prepa- 
ration of  roots  of  teeth  and  the  fitting  of  bands  and  caps  in 
crown-  and  bridge-work. 

EucAiNE  Hydroohlorate^  "A." 

Derivation. — Eucaine  hydrochlorate  "A"  is  obtained  by  the 
action  of  one  molecule  of  ammonia  upon  three  molecules  of 
aceton  which  forms  triacetonamin.  This  is  then  transformed 
into  dry  triacetonamincyanhydrin  by  hydrocyanic  acid. 

This  compound  when  saponified  becomes  triacetonall?;amin- 
carbonic  acid,  ammonia  being  given  off  in  the  process. 

When  benzylated  and  methylated  we  get  n-methyl-benzoyl- 
tetramethyly-oxjrpiperidincarbonic  acid-methylester,  or  eucaine. 

As  will  be  apparent  from  this  synthesis,  eucaine  is  not  a 
coal-tar  product. 


ANESTHETICS.  97 

Properties  and  Actions. — Eucaine  (A)  is  a  white,  neutral, 
crystalline  powder,  soluble  in  ten  parts  cold  water,  making 
about  nine  per  cent,  solution.  This  solution  is  stable  and  may 
be  boiled  without  suffering  deterioration.  It  may  be  employed 
in  all  cases  where  cocaine  is  used  and  in  similar  strength  or 
stronger,  since  the  two  drugs  are  quite  similar  as  regaras  the 
rapidity,  intensity,  and  duration  of  anesthesia;  eucaine,  how- 
ever, being  much  less  toxic. 

Therapeutics. — Eucaine  is  employed  as  a  local  anesthetic 
for  minor  surgical  operations,  and,  as  has  been  indicated,  the 
only  important  difference  of  this  drug  and  cocaine,  physiologi- 
cally or  therapeutically,  is  the  difference  in  their  toxic  effects. 
It  is  claimed,  after  many  careful  experiments,  that  the  pulse  is 
not  materially  affected  by  the  use  of  eucaine,  either  in  rate  or 
character.  Some  writers  have  stated  that  unpleasant  disturb- 
ances of  sensation  follow  the  use  of  this  drug,  particularly  when 
used  upon  the  pharynx.  These  disturbances,  however,  are  less 
unpleasant  and  less  marked  than  those  produced  by  cocaine, 
and  are  more  transient,  and,  speaking  generally,  after  the  lapse 
of  an  hour  from  the  time  of  application,  the  subjective  sensa- 
tions may  be  described  as  normal. 

Dental  Uses. — In  dental  practice,  eucaine,  from  two  to  five 
per  cent,  solution,  is  employed  as  a  local  anesthetic  in  the  ex- 
traction of  teeth;  it  is  applied  locally,  by  freely  bathing  the 
parts,  for  lancing  painful  abscesses;  is  injected  hypodermatically 
in  minor  surgical  operations  in  the  mouth,  such  as  the  removal 
of  small  tumors,  necrosed  bone,  and  in  operations  upon  the 
antrum  of  Highmore.  Eucaine  may  also  be  employed,  cata- 
phorically,  for  the  obtunding  of  sensitive  dentine,  the  removal 
of  the  dental  pulp,  etc.  The  writer  has  secured  very  satisfactory 
results  with  a  ten  per  cent,  solution  of  the  drug,  both  as  a  local 
anesthetic  in  operations  upon  the  antrum,  and  in  conjunction 
with  cataphoric  instruments  in  the  usual  dental  operations. 


98  DENTAL   PATHOLOGY  AKD  DENTAL   MEDICINE. 

STIMULAE^TS. 

Stimulants  are  medicinal  agents  whicli  increase  organic 
activity.  The  most  powerful  and  rapid  in  action,  though  tran- 
sient in  effect,  are  termed  diffusible  stimulants,  while  the  local 
stimulants,  which  are  of  a  vegetable  nature,  containing  a  vola- 
tile oil,  are  termed  aromatic. 

Among  the  first  class  are  such  agents  as  the  alcoholic  prep- 
arations, ammonia,  camphor,  ether,  nitrite  of  amyl,  myrrh,  nor- 
mal saline  solution,  coca,  caffbae,  etc. 

The  principal  members  of  the  class  of  aromatic  stimu- 
lants are  capsicum,  oil  of  cloves,  peppermint,  etc.  Heat  and 
cold  also  act  as  local  stimulants. 

Alcohol,  C2HgO. 

Derivation. — Alcohol  is  obtained  by  repeated  distillations 
from  the  product  of  fermented  grain  or  starchy  substances, 
easily  converted  into  grape  sugar,  which  in  the  presence  of  and 
by  the  growth  of  low  vegetable  organisms  (the  yeast  plant,  etc.) 
splits  up  into  alcohol  and  CO^.  Commercial  alcohol  contains 
about  90  per  cent,  of  absolute  alcohol  with  10  per  cent  of  water. 

Properties  and  Action. — Alcohol  is  a  colorless,  inflammable 
fluid,  wholly  vaporizable  by  heat,  and  unites  in  any  proportion 
with  water  and  ether.  It  possesses  a  pungent  odor  and  burning 
taste.  All  of  the  alcoholic  preparations  are  powerful  diffusible 
stimulants,  causing  general  exhilaration  of  spirits. 

In  large  doses,  however,  it  is  a  depressant,  producing  mus- 
cular inco-ordination  and  the  effects  of  narcotic  poisons,  ending 
in  delirium,  coma,  and  death. 

The  Most  Important  Alcohols  are: — 

Methylic  Alcohol,  C^Ufi,  methyl  hydrate,  wood  spirit. 

Ethylic  Alcohol,  C2HgO,  ethyl  hydrate,  grain  spirit. 

Amylic  Alcohol,  C-H^oO,  amyl  hydrate,  potato  spirit,  also 
occurs  with  the  ethylic  alcohol,  in  excessive  distillations  of  fer- 
mented grain. 


STIMULAA'TS.  99 

Principal  Preparations  of  Alcohol: — 

Absolute  Alcohol,  rarely  obtainable  in  the  shops,  however, 
stronger  than  98  per  cent. 

Alcohol  contains  about  91  per  cent,  of  absolute  alcohol. 

Alcoholis  Dilutum  contains  equal  parts  of  alcohol  and 
water. 

Spiritus  Frumenti,  whisky  from  rye,  corn,  barley,  and 
potatoes,  contains  from  45  to  50  per  cent,  of  alcohol. 

Rum,  obtained  by  the  distillation  of  fermented  molasses. 

Wines — ^port  wine,  sherry  white  wine  (made  by  fermenting 
the  juice  of  the  grape  without  the  seeds,  stems,  or  skins)  ;  red 
wine  (from  the  juice  of  grapes  with  their  skins)  ;  champagne, 
claret,  Hhine,  etc.  These  contain  from  5  to  40  per  cent  of 
alcohol. 

Beer  by  slow  fermentation,  contains   2  to  3  per  cent,  alcoliol. 
Ale,  by  rapid  "  •'         2  to  6  "  " 

Porter   and   stout  '•         4  to  G  "  " 

Therapeutic  Uses. — The  alcoholic  preparations  are  most  val- 
uable agents  in  disease,  for  appropriate  cases;  they  are  em- 
ployed as  stimulants  in  acute  inflammations,  such  as  pneu- 
monia, pleurisy,  bronchitis,  phthisis,  and  in  the  last  stages  of 
typhoid  fever,  diphtheria,  acute  neuralgia,  etc.  In  insomnia 
from  cerebral  anaemia,  small  doses  of  some  alcoholic  stimulant 
at  bedtime  are  found  beneficial.  In  poisoning  by  cardiac  de- 
pressants and  snake  venom,  alcohol,  freely  sustains  the  heart. 
In  chloroform  anesthesia,  an  ounce  of  whisky  beforehand  will 
sustain  the  heart  and  prolong  narcosis. 

Dental  Uses.- — In  the  administration  of  nitrous  oxide  gas, 
a  small  quantity  of  wine  taken  beforehand  will  often  be  found 
beneficial,  increasing  the  heart's  action  at  about  the  time  the 
effects  of  the  anesthetic  are  passing  off.  In  painful  operations 
upon  the  teeth,  I  have  found  small  doses  of  sherry  or  brandy 
to  be  verv  beneficial. 


100  DENTAL  PATHOLOGY  AND  DENTAL  MEDICINE. 

As  a  styptic,  it  arrests  hemorrliags  by  coagulating  the  blood 
by  its  effects  "upon  albumin,  and  contracts  the  mouth  of  the 
vessels  by  its  astringent  properties. 

For  suppurating  wounds  it  is  a  useful  antiseptic  dressing. 

For  the  treatment  of  soft  and  sensitive  dentine,  and 
for  drying  cavities  preparatory  to  filling,  absolute  alcohol  is 
generally  an  efficient  agent;  after  drying  the  cavity  with  cotton 
or  bibulous  paper,  it  should  be  bathed  v^ith  alcohol,  which  evap- 
orates rapidly  and  causes  the  almost  perfect  absorption  of 
moisture  from  the  dentine. 

Treatment  of  Acute  Alcoholism. — ^Evacuate  the  stomach, 
administer  ammonia  cautiously  by  inhalation,  apply  warmth  to 
the  extremities  and  cold  affusion  to  the  head,  and,  if  need  be, 
artificial  respiration.  *   . 

Ammonia.  • 

Medicinal  Properties  and  Action. — It  exists  most  com- 
monly in  the  form  of  ammonia  gas,  NHg;  which,  dissolved  in 
water,  is  the  aqua  ammonise  of  conunerce.  It  is  intensely  alki- 
line,  and  is  an  irritant  to  the  mucous  membrane.  When  inhaled 
it.  acts  as  a  stimulant,  especially  as  an  antagonist  of  cardiac  de- 
pressants. Prolonged  inhalation  induces  spasmodic  coughing, 
a  sense  of  suffocation,  and  inflammation  and  oedema  of  the 
glottis;  when  swallowed,  the  aqua  sets  up  violent  inflammation 
of  the  passages  and  stomach. 

The  salts  of  ammonia,  in  medicinal  doses,  are  stimulating 
expectorants,  and  stimulate  the  heart's  action;  while  in  large 
doses  or  continued  use  they  produce  rapid  emaciation,  by  im- 
pairing digestion  and  increasing  tissue  waste.  In  large  doses 
they  also  injure  the  red  blood  corpuscles. 

Principal  Preparations: — 

Aqua  ammoniae,  water  of  ammonia,  containing  10  per  cent, 
of  the  gas  in  water.    Dose,  "niv-xxx,  diluted. 


STIMULANTS.  101 

Aqua  ammoniae  fortior,  containing  28  per  cent,  of  the  gas 
in  solution. 

Ammonium  carbonate.    Dose  gr.  ij-x. 

Ammonium  chloride,  sal  ammoniac.    Dose,  gr.  j-xx. 

Ammonia  spirits  (a  10  per  cent,  solution  of  aqua  ammoniae 
in  alcohol).     Dose,  "nix-Sj,  diluted. 

Aromatic  spirits  of  ammonia,  the  carbonate  with  aro- 
matics  (oil  of  lemon,  lavender,  etc.,  and  alcohol  and  water). 
Dose,  TTLx-^ij. 

Ammonia  liniment,  aqua  ammonias,  30  per  cent.,  and  cot- 
ton-seed oil,  70  per  cent. 

Ammonium  nitrate,  used  in  preparing  nitrous  oxide  gas. 

Ammonium  sulphate,  used  in  preparing  other  ammonium 
salts,  etc. 

Camphor^  CjoH^gO. 

Source. — Camphor  is  a  white,  concrete,  and  translucent  gum, 
obtained  from  the  volatile  oil  of  the  camphor  laurel,  an  ever- 
green tree  indiginous  in  China,  Japan,  Formosa,  etc.  Refined 
camphor  is  prepared  in  large  circular  cakes,  one  to  two  inches 
thick. 

Properties  and  Action. — Camphor  is  slightly  soluble  in 
water  (about  1  to  1300),  but  freely  in  alcohol,  ether,  chloroform, 
oils,  and  mill^.  Alcohol  forms  a  75  per  cent,  solution.  It  has 
a  penetrating,  fragrant  odor,  a  bitter,  pungent  taste,  leaving  a 
slight  sense  of  coolness.  It  is  a  stimulant,  anodyne,  diaphoretic, 
antiseptic,  and  irritant. 

In  medicinal  doses  it  temporarily  increases  the  heart's 
action,  stimulates  respiration  and  mental  activity,  promotes 
perspiration,  and  allays  pain  and  spasm. 

Large  doses  depress  the  heart  and  excite  narcotic  symptoms, 
and  have  proved  fatal. 


102  DENTAL  PATHOLOGY  AND  DENTAL   MEDICINE. 

Principal  Preparations:  — 

Aqua  camphorae,  camphor  water  (8  parts  of  camphor  to 
1000  of  distilled  water,  with  16  parts  of  alcohol  to  aid  in  the 
suspension  of  camphor).     Dose,  3j-iv. 

Spiritus  camphorae,  spirit  of  camphor  (camphor,  Siv,  alco- 
hol, Oj).     Dose,  TTLv-xx. 

Linimentum  camphorae,  camphor  liniment  (camphor  1 
part  to  olive  oil  4  parts). 

Linimentum  saponis,  soap  liniment  (soap  10  parts,  cam- 
phor 5,  oil  rosemary  1,  alcohol  70,  water  15).  Is  an  anodyne 
and  mild  irritant  for  sprains,  rheumatic  pains,  etc. 

Dental  Use. — In  dental  practice  the  spirit  of  camphor  is 
sometimes  employed  by  local  application  to  allay  the  pain  of 
sensitive  dentine,  and  that  which  sometimes  follows  the  ex- 
traction of  teeth,  and  the  wounding  of  pulps  of  teeth.  Cam- 
phor is  also  employed  in  the  treatment  of  putrescent  root  canals 
of  teeth.  It  is  also  one  of  the  ingredients  of  the  celluloid  base 
for  artificial  teeth. 

Nitrite  of  Amyl,  C.H^^NOg. 

Derivation. — Nitrite  of  amyl  is  produced  by  the  action  of 
nitric  or  nitrous  acid  upon  amylic  alcohol. 

Properties  and  Action.— Nitrite  of  amyl  is  a  clear,  yellow- 
ish, oily  liquid.  It  has  an  ethereal  odor,  and  is  very  volatile 
and  inflammable;  it  is  insoluble  in  water,  but  soluble  in  alcohol, 
ether  and  chloroform.  It  is  used  by  inhalation,  causing  great 
cardiac  activity,  vascular  dilatation,  flushing  of  the  face,  a 
sense  of  fullness  of  the  brain,  and  complete  resolution  of  the 
muscular  system.  It  is  a  muscle  poison,  and  when  the  vapor 
is  applied  directly  to  the  muscular  or  nervous  tissues  it  arrests 
their  functional  activity. 

Dental  Use. — Nitrite  of  amyl,  being  a  powerful  stimulant 
to  the  heart,  is  employed  in  syncope  and  chloroform  narcosis. 
It  is  also  used  in  epileptic  attacks  and  other  convulsive  or  spas- 


STIMULANTS.  103 

modic  diseases.  Cases  are  reported  where  nitrite  of  amyl  has 
restored  the  patient  after  artificial  respiration  had  failed.  Care, 
however,  must  be  observed  in  its  use,  as  it  is  a  powerful  and 
dangerous  agent. 

Dose  of  nitrite  of  amyl  by  inhalation  is  from  TTLij  to  TTLv. 
JSTot  more  than  two  or  three  drops  should  be  administered  to 
weak  and  nervous  patients  who  are  susceptible  to  its  influence. 

Myrrh. 

Source. — Myrrh  is  a  resinous  exudation  from  a  small  tree 
grown  in  Arabia  and  the  northeastern  coast  of  Africa,  known 
as  the  Balsamodendron  myrrha.  It  is  a  spontaneous  exuda- 
tion from  the  stems  of  the  tree,  which  collects  in  small  masses 
upon  the  bark. 

Properties  and  Action. — Myrrh  is  brittle  and  is  easily  pul- 
verized. It  is  of  a  reddish-yellow  color,  translucent,  with  an 
aromatic  taste  and  a  peculiar  fragrant  odor.  When  pulverized 
the  powder  is  of  a  light  yellow  color,  if  pure.  In  medicinal 
doses,  myrrh  is  a  stimulant  and  astringent.  It  stimulates  the 
digestive  organs  and  improves  the  appetite,  but  in  larger  doses 
it  acts  as  an  irritant  to  the  gastro-intestinal  membrane.  It  is 
employed  externally  as  a  local  application  to  inflamed,  iilcerated, 
and  relaxed  tissues,  for  stimulating  and  astringent  effect. 

Dose — Powdered  myrrh,  gr.  x  to  ^ss,  in  pill  form  or  sus- 
pended in  water.  Tincture  of  myrrh,  ^ss  to  j  (myrrh  Biij, 
alcohol  Oij). 

Dental  Use. — The  tincture  of  myrrh,  diluted,  forms  an  ex- 
cellent gargle  and  mouth-wash,  and  a  stimulating  lotion  for 
spongy  and  inflamed  gums.  The  powder  is  employed  as  an 
ingredient  of  many  dentifrices  for  its  astringent  properties. 

Capsicum. 
Source. — Capsicum,  or  Cayenne  Pepper,  is  the  fruit  of  Cap- 
sicum fastigiatunfhj  a  plant  of  tropical  Africa  and  America.    Its 


104  DENTAL  PATHOLOGY  AND  DENTAL   MEDICINE. 

pungent  odor  and  hot  taste  are  due  to  its  very  acrid  and  volatile 
principle,  called  capsicine. 

Medicinal  Properties  and  Actions. — Capsicum  in  medic- 
inal doses  is  a  powerful  stimulant.  It  produces  a  sensation  of 
warmth  in  the  stomach,  and  a  general  glow  over  the  body;  it 
stimulates  the  circulation  and  digestive  process,  but  in  ex- 
cessive doses  it  acts  as  an  irritant  poison. 

Preparations : — 

Tincture  Capsicum.    Dose,  "niv-Sj. 

Powdered  Capsicum.  Dose,  gr.  v-x  in  pills. 

Emplastrum  Capsicum.     A  most  excellent  plaster. 

Dental  Use. — Capsicum  in  tincture  or  plaster  form,  pre- 
ferably the  latter,  is  very  serviceable  in  dental  periostitis,  as  it 
aids  in  establishing  resolution  or  hastens  suppuration.  It  is 
also  an  excellent  stimulating  gargle,  tin«t.  capsicum,  5ss  to 
rose  water,  Sviij. 

Oil  of  Clo\^s. 

Source. — The  oil  of  cloves  is  obtained  from  the  dried,  unex- 
panded  flowers  of  the  Eugenia  caryophyllata,  an  evergreen  tree 
of  the  myrtle  order,  a  native  of  the  Indies. 

Properties  and  Actions. — The  oil  of  cloves,  when  fresh,  is 
a  clear  and  colorless  preparation;  it  has  a  pungent,  spicy  taste, 
and  a  fragrant  odor.  Is  an  aromatic  stimulant,  irritant  and 
antiseptic.  It  is  sometimes  administered  to  relieve  nausea,  and 
prevent  griping  when  combined  with  purgatives,  also  to  modify 
the  action  of  other  medicines.    Dose,  TTtj-v. 

Dental  Use. — The  oil  of  cloves  is  employed  in  dental  prac- 
tice to  relieve  odontalgia,  by  introducing  two  or  three  drops 
into  the  carious  cavity  of  the  aching  tooth,  relieving  the  pain 
by  its  stimulating  effect  upon  the  pulp.  It  is  sometimes  used 
for  the  same  purpose  in  combination  with  other  agents,  and  has 
the  effect  of  rendering  carbolic  acid  more  pleasant,  without  in- 
terfering with  its  action.  It  is  used  also  by  microscopists  to 
clarify  preparations  for  mounting. 


STIMULANTS.  105 

Eugenol  (C^qHj^oO.O  is  an  active  principle  of  oil  of  cloves. 
It  is  sometimes  called  an  acid,  as  it  possesses  some  acid  quali- 
ties. It  is  a  clear,  colorless  oil,  and  its  odor  and  taste  resemble 
those  of  the  oil  of  cloves.  It  is  an  excellent  antiseptic  for 
dental  uses. 

Peppermint. 

Source. — ^Mentha  piperita,  or  peppermint,  is  grown  every- 
Vfhere,  and  as  a  plant  is  familiar  to  every  one.  The  leaves  and 
tops  are  used  for  medicinal  purposes. 

Properties  and  Actions. — The  properties  of  peppermint  are 
due  to  a  volatile  oil,  in  which  form  it  is  generally  used.  It  is 
an  aromatic  stimulant,  carminative  and  antispasm.odic,  and  local 
anodyne  and  anesthetic  when  evaporation  is  prevented  after 
being  applied  to  the  surface. 

Preparations : — 

Oil  of  Peppermint  (consisting  largely  of  menthol).     Dose, 

mj-v. 

Peppermint  Water  (2  parts  of  the  oil  to  1000  of  distilled 
water).    Dose  indefinite. 

Essence  of  Peppermint  (10  per  cent,  of  oil  with  1  per  cent, 
of  the  powdered  herb  in  alcohol.     Dose,  trtx-xxx. 

Dental  Use. — Local  anodyne  and  anesthetic. 

Sodium  Chloride. 

Normal  saline  solution  (0.6  per  cent,  sodium  chloride).  In 
emergency  cases  it  is  sometimes  necessary  to  inject  a  stimulant 
directly  into  the  vein,  and  as  this  saline  solution  correspends 
so  closely  in  salinity  to  the  blood  serum  it  is  regarded  today  one 
of  the  most  important  means  of  stimulation.  Serious  loss  of 
blood,  and  extreme  depression  or  collapse  would  indicate  its  use. 

Normal  saline  solution  is  prepared  by  dissolving  6  parts  so- 
dium chloride  in  1000  parts  of  sterile  water,  and  as  has  been 
indicated  is  injected  intravenously. 


106  DENTAL   PATHOLOGY  AND   DENTAL   MEDICINE. 

TONICS. 

Tonics  are  agents  which  give  healthful  activity  and  vigor  to 
the  functions,  gradually  imparting  strength  and  tone  to  the 
system,  that  is,  without  preternatural  excitement.  They  are 
divided  into  vegetable  and  mineral  tonics. 

Principal  among  the  vegetable  tonics  are  cinchona,  nux 
vomica,  digitalis,  cimicifuga,  and  eucalyptus. 

While  the  principal  mineral  tonics  are  the  preparations 
of  iron,  arsenic,  zinc,  sulphuric  acid,  nitric  acid,  muriatic 
acid,  etc. 

Cinchona   (Peruvian  Bark). 

Source. — Cinchona  is  the  bark  of  any  variety  of  cinchona. 
The  different  species  of  this  tree  are  natives  of  the  mountains 
of  western  South  America,  especially  in  Peru  and  Bolivia, 
though  they  have  been  planted  and  are  grown  in  Indi%  Ceylon 
and  Burmah. 

The  medicinal  properties  of  these  barks  depend  upon  the 
alkaloids  they  contain,  which  are  in  varying  proportions,  usu- 
ally from  3  to  4  per  cent.,  at  least  2  per  cent,  of  which  is 
quinine,  this  being  the  most  important. 

Principal  preparations  of  cinchona  and  its  alkaloids  are 
as  follows : 

Powdered  cinchona.    Dose,  gr.  x-3iij. 

Tincture  cinchona  (strength  20  per  cent.).    Dose,  3j-,^ss. 

Extract  cinchona  (in  pill).    Dose,  gr.  j-x. 

Sulphate  of  Quinine.    Dose,  gr.  j-xx. 

Sulphate  of  cinchonidine  (one-half  the  strength  of  qui- 
nine). Dose,  gr.  ij-xxx.  Much  used  in  hospital  and  dispensary 
work. 

Properties  and  Actons. — The  different  varieties  of  cin- 
chona are  named  according  to  their  color.  Yellow  cinchona — 
cinchona  flava;  pale  cinchona — cinchona  pallida;  red  cinchona 
• — cinchona  rubra.     The  powder  from  the  yellow  bark  is  of  an 


TONICS.  107 

orange  color;  has  a  more  bitter  taste  than  the  other  barks,  con- 
taining more  of  the  alkaloid  quinine.  Cinchona  is  a  bitter 
tonic,  astringent,  antipj'^retic,  and  antiseptic.  The  alkaloid 
quinine  is  preferable  for  ordinary  use,  as  a  much  larger  quan- 
tity of  the  powdered  bark  is  necessary  to  obtain  the  full  effects, 
often  causing  derangement  of  the  stomach,  headache,  and  con- 
stipation. 

Dental  Uses. — In  dental  practice  quinine  is  employed  in 
from  five  to  ten  grain  doses  as  a  tonic,  and  in  the  treatment  of 
neuralgia  when  due  to  malaria.  Cinchona  is  also  used  as  an 
antiseptic.  "The  powder  dusted  over  unhealthy  wounds  will 
arrest  putrefaction  and  promote  healthy  cicatrization.  Quinine 
will  destroy  minute  organisms,  and  preserve  substances  from 
decomposition."*  Cinchona  is  also  employed  for  its  antiseptic 
and  tonic  properties  as  an  ingredient  in  certain  dentifrices. 

Nux  Vomica. 

Source. — Nux  vomica  is  the  seeds  of  the  Stryclmos  nucis 
vomica,  a  tree  of  the  family  Strychnoides,  which  grows  in 
India.  These  seeds  have  been  long  sold  in  the  shops  under  the 
names  of  nux  vomica,  bachelor's  buttons,  poison  nuts,  etc.,  and 
for  a  long  time  were  used  only  for  such  purposes  as  poisoning 
rats. 

Medicinal  Properties  and  Actons. — Nux  vomica  contains 
two  all'^ialoids,  strychnine  and  brucine,  to  which  its  medicinal 
properties  are  chiefly  due.  Brucine  has  only  y^,,  the  strength 
of  strychnine,  but  they  are  otherwise  identical,  physiologically 
and  therapeutically. 

In  small  doses  nux  vomica  is  a  bitter  tonic,  exciting  the 
secretions  and  stimulating  the  functions  of  the  body. 

In  full  doses  (strychnine  gr.  Y^q)  the  function  of  the  spinal 
cord  is  exalted,  causing  tetanic  spasms  of  the  extensor  muscle, 

*Gorgas'   ''Dental  Medicine." 


108     .  DENTAL  PATHOLOGY  AND  DENTAL   MEDICINE. 

the  lower  jaw  is  stiff,  the  pupils  dilated,  and  the  face  wears  an 
unmeaning  smile. 

In  toxic  doses  (strychnine  gr.  ^^2)  the  function  of  the  spinal 
cord  is  paralyzed,  respiration  is  arrested,  death  following  from 
asphyxia;  consciousness  is  preserved,  however,  until  CO2  nar- 
cosis takes  place. 

Treatment  of  Strychnine  Poisoning. — The  antidote  is 
tannic  acid,  which  forms  an  insoluble  tannate ;  then  the  stomach 
pump  should  be  employed  or  emetics  administered,  after  which 
the  patient  should  be  kept  perfectly  quiet. 

The  antagonists  are  chloral,  chloroform,  and  potassium 
bromide;  the  last  named,  though,  is  rarely  used,  on  account  of 
its  being  so  slow  of  action. 

The  bladeer  must  be  evacuated  frequently,  lest  a  reabsorp- 
tion  of  the  poison  take  place. 

Preparations : —  ^ 

Abstract  of  Nux  Vomica. — Dose,  gr.  V2  gradually  in- 
creased to  gr.  j. 

Tincture  of  Nux  Vomica  (20  per  cent,  of  the  drug). 
Dose,  TUJ-x. 

Extract  of  Nux  Vomica.     Dose,  gr.  i/g-j. 

Fluid  Extract  of  Nux  Vomica.    Dose,  nij-v. 

Sulphate  of  Strychnine.    Dose,  gr.  yioo"V2o- 

Dental  Uses. — Where  a  cardiac  or  nerve  tonic  is  required, 
nux  vomica  and  its  chief  alkaloid  hold  the  first  rank. 

Digitalis. 
Source. — Digitalis,  or  foxglove,  is  the  leaves  of  Digitalis 
purpurea,  or  purple  foxglove;  the  leaves  of  the  second  year's 
growth  are  considered  the  best.  The  plant  grows  wild  in 
Europe,  and  is  cultivated  in  this  country,  where  it  is  sometimes 
seen  in  private  gardens,  grown  for  its  beautiful  spike  of  purple 
flowers.  The  Shakers  cultivate  it  quite  extensively  for  the 
drug  market. 


TONICS.  109 

Medicinal  Properties  and  Actions. — Digitalis  is  chiefly 
used  in  disease  for  its  tonic  and  diuretic  properties,  its  tonic 
effect  upon  the  heart,  principally;  though  the  heart  is  slowed 
by  its  action,  its  force  is  at  the  same  time  increased.  For  the 
full  cardiac  effects  the  recumbent  posture  should  be  maintained. 
When  the  doses  are  large,  severe  gastric  disturbance  is  caused. 
In  toxic  doses,  the  muscles  and  peripheral  nerves  are  paralyzed; 
respiration  is  first  slowed  and  then  becomes  rapid  and  feeble; 
coma  and  convulsions  followed  by  death  from  the  sudden 
paralysis  of  the  heart. 

Preparations  and  Doses: — 

Digitalis  (the  leaves).     Dose,  gr.  ss-iij. 

Abstract  of  Digitalis.  Dose,  gr.  %^-j  (strength  200  per 
cent.). 

Extract  of  Digitalis.  Dose,  gr.  ^ / ^.-]. 

Fluid  Extract  of  Digitalis.    Dose,  Tixj-iij. 

Tincture  of  Digitalis  (15  per  cent.).    Dose,  iilv-xx. 

CiMICIFUGA. 

Source. — Cimicifuga,  or  the  black  snakeroot,  is  the  root  of 
the  Cimicifuga  racemosa,  a  common  plant  in  the  United  States. 

Medicinal  Properties  and  Actions. — Cimicifuga  has  a 
bitter  and  nauseous  taste,  somewhat  resembling  that  of  opium. 
It  is  an  efficient  cardiac  tonic,  antispasmodic,  diaphoretic,  and 
diuretic.  It  is  feebler  in  its  action  than  digitalis,  and  should 
be  used  more  frequently  when  the  latter  drug  is  indicated. 

Preparations  and  Doses: — 

Fluid  Extract  of  Cimicifuga.     Dose,  tiiv-xxx. 

Tincture  of  Cimicifuga  (20  per  cent,  in  strength).  Dose, 
TUxx-lx  (3j). 

Eucalyptus. 
Source. — Eucalyptus    is    obtained    from   the    leaves    of    the 
Eucalyptus  globulus,  or  "blue  gum  tree,"  a  native  of  Australia, 
but  is  now  grown  in  Northern  Africa,  Southern  Europe  and  in 
the  United  States. 


110  DENTAL  PATHOLOGY  AXD  DEKTAL   MEDICINE. 

Properties  and  Actions. — The  leaves  are  the  only  portion 
of  the  tree  which  possesses  medicinal  qualities,  the  fresh  being 
more  active  than  the  dried  leaves.  Their  medicinal  properties 
are  due  to  a  volatile  oil,  called  oleum  eucaljTpti,  which  contains 
three  oils,  eucalyptene,  turpene,  and  cymol,  which  distilled  over 
at  different  temperatures,  the  first  product  being  the  most  im- 
portant. Eucalyptus  promotes  appetite  and  digestion,  and  in- 
creases the  heart's  action. 

In  large  doses  it  causes  indigestion,  nausea,  diarrhoea,  and 
great  muscular  weakness,  and  if  continued  will  cause  irritation 
and  congestion  of  the  kidneys.  It  is  eliminated  by  the  skin, 
bronchial  mucous  m.embrane,  and  kidneys,  the  secretions  of 
which  become  strongly  odorous,  owing  to  the  presence  of  the 
oil.  Eucalyptus  is  also  an  antiseptic,  disinfectant,  sedative, 
and  diaphoretic,  "and  has  anti-malarial  properties,  absorbing 
noxious  germs,  as  well  as  enormous  quantities  of  water  from 
the  soil,  and  by  its  emanations  purifying  the  atmosphere  in 
the  vicinity.  It  is  largely  cultivated  in  malarial  districts  for 
these  properties,  and  has  rendered  habitable  a  portion  of  the 
deadly  Koman  Campagna."* 

Preparations  of  Eucalyptus: — 

Extract.    Dose,  gr.  j-xv. 

Fluid  Extract.     Dose,  ttLxx-3j. 

Tincture.    Dose,  f^ss-ij. 

Oil.     Dose,  niv-xx  in  emulsion  or  capsules. 

Dental  Use. — In  dental  practice  the  oil  of  eucaljiptus  is 
employed  either  alone  or  combined  with  iodoform,  for  its 
antiseptic  properties,  in  the  treatment  of  putrescent  pulps  of 
teeth  and  chronic  alveolar  abscesses.  This  combination  has 
also  proven  very  efficient  in  the  treatment  of  necrosis  and  caries 
of  the  bone  of  the  jaws. 


♦Potter's  "Materia  Medica." 


TONICS.  Ill 

By  taking-  advantage  of  tlie  solvent  effects  of  eucalyptol 
upon  the  giitta-percha,  it  will  be  found  of  great  benefit  in  the 
insertion  of  fillings  of  this  material. 

Iron. 

Ferrum,  or  ironj,  is  a  metal  of  a  bluish-gray  color,  fibrous  in 
texture,  is  hard,  ductile,  malleable,  and  magnetic.  Chemical 
analysis  demonstrates  the  presence  of  iron  in  the  blood,  1  part 
to  230  of  red  corpuscles,  also  in  the  gastric  juice,  chyle,  bile, 
lymph,  urine,  milk,  and  pigment  of  the  eye. 

Properties  and  Actions. — Iron  taken  into  the  stomach  in 
the  metallic  state,  meeting  with  the  acids  of  that  cavity,  is 
dissolved,  which  causes  an  evolution  of  hydrogen  gas,  and  gives 
to  the  iron  molecular  activity.  Given  tnedicinally  in  small 
doses,  the  salts  of  iron  act  through  and  upon  the  blood,  improv- 
ing its  quality  and  increasing  the  number  of  red  corpuscles; 
they  also  promote  the  appetite  and  improve  digestion,  and  hence 
it  is  recognized  as  one  of  the  most  efficient  tonics. 

In  large  doses  these  salts  cause  nausea  and  vomiting  and 
act  as  irritants.  Or  the  prolonged  administration  of  small 
doses  exhausts  the  gastric  glands  by  over-stimulation. 

Monsel's  preparations  of  iron  are  principally  used  exter- 
nally, for  hemorrhage,  and  are  considered  to  be  among  the  very 
best  styptics  in  use.  When  internally  employed  it  is  for  their 
hemostatic  effect  in  hemorrhage  from  remote  organs.  In  admin- 
istering iron  care  should  be  exercised,  as  nearly  all  the  prepara- 
tions are  more  or  less  astringent,  and  act  injuriously  on  the 
teeth. 

Contra-indications. — Iron  should  never  be  given  when 
plethora  (a  superabundance  of  blood)  exists,  especially  when 
accompanied  with  a  hemorrhagic  tendency. 

Principal  Preparations : — 

Tincture  of  the  Chloride  of  Iron.    Dose,  niv-xx. 


112  DENTAL  PATHOLOGY  AND  DENTAL  MEDICINE. 

Powdered  Sulphate  of  Iron,  Monsel's  Powder.  Dose,  gr. 
ss-iij,  in  pill;  used  also  as  a  styptic. 

Solution  of  Subsulphate  of  Iron,  or  Persulphate,  Monsel's 
Solution.  Possesses  powerful  astringent  properties;  used  only 
as  a  styptic. 

Dental  Uses. — ^In  dental  practice  the  chief  indications  for 
iron  are  where  hemorrhage  follows  the  extraction  of  teeth,  or 
from  any  other  cause,  such  as  wounds  of  the  gums  and  mucous 
membrane.  IVTonseFs  solution  or  powder  is  employed  for  this 
purpose.     See  chapter  on  Extraction  of  Teeth. 

AeseniC;,  As. 

Properties. — Arsenic  is  a  brittle,  granular  metal,  of  steel- 
gray  color,  is  very  combustible,  and  volatilizes  before  melting, 
the  vapor  having  an  odor  like  that  of  garlic.  It  is  a  powerful 
poison,  not  of  itself,  however,  but  by  virtue  of  the  facility  with 
which  it  absorbs  oxygen.  It  is  generally  found  in  cobalt  ore. 
It  is  not  employed  as  medicine  in  its  native  state. 

Preparations : — 

Arsenious  Acid  (?),  White  Arsenic,  "Ratsbane."    Dose,  gr 

Veo  to  Vio- 

Solution  of  Arsenious  Acid,  1  per  cent,  solution  (strength, 
Vioo)  with  hydrochloric  acid  and  distilled  water.  Dose,  TTLij-x, 
after  meals. 

Solution  of  Potassium  Arsenite,  Fowler's  solution  (strength 
y^oo).    Dose,  TTlij-x,  after  meals. 

White  Oxide  of  Arsenic  (AsgOg),  Arsenious  Acid,  is  in 
the  form  of  irregnilar  solid  lumps,  having  a  chalky  appearance 
externally,  though  it  is  often  perfectly  transparent  internally. 
It  is  usually  furnished  in  the  shops,  however,  in  the  form  of  a 
fine  white  powder,  and  is  often  adulterated  with  chalk  or  lime. 
It  is  odorless  and  has  a  faint  sweetish  taste. 

Physiological  Actions. — In  small  doses,  arsenic  is  a  gen- 
eral tonic,  promoting  the  appetite,  digestion,  and  cardiac  action, 


TONICS.  113 

stimulates  mental  activity,  and  causes  rotundity  of  form  and 
■  clear  skin.  In  large  doses  it  becomes  a  violent  corrosive  poison, 
creates  skin  eruptions  and  itching  of  the  eyelids,  nausea, 
dysentery,  and  an  irritable  and  feeble  heart,  death  following 
from  narcotism.     Externally,  it  is  a  powerful  escharotic. 

Toxicology. — The  antidote  to  arsenic  is  the  hydrated  oxide 
of  iron.  After  the  prompt  evacuation  of  the  stomach  this  should 
be  administered,  the  dose  being  eight  times  the  quantity  of 
the  poison  taken.  This  should  be  followed  by  mucilaginous  or 
oily  drinks,  to  protect  the  mucous  membrane,  and  iodide  of 
potassium  or  alkaline  mineral  waters,  to  promote  elimination. 

Tests  for  Arsenic. — There  are  a  number  of  tests  for  arsenic, 
the  following  being  considered  the  best :  If  in  a  solid  state,  place 
the  suspected  material  on  burning  charcoal,  when  the  arsenic,  if 
present,  will  become  deoxidized  and  emit  the  garlic  odor  spoken 
of  above.  When  in  an  aqueous  solution,  it  may  be  detected  by 
adding  sulphide  of  ammonium,  which  produces  a  yellow  sul- 
phide of  arsenic,  or  the  addition  first  of  ammonia,  then  a  small 
quantity  of  nitrate  of  silver,  will  produce  a  light  yellow  arsenite 
of  silver.  Again,  the  addition  of  potassa  and  sulphate  of  copper 
produces  a  light  gTeen  arsenite  of  copper. 

Marsh's  Test. — The  most  delicate  test  for  arsenic  consists 
in  subjecting  the  material  to  the  action  of  nascent  hydrogen.* 
The  arsenic  is  deoxidized  and  forms  with  the  hydrogen  arseni- 
uretted  hydrogen  gas;  this  also  has  the  peculiar  odor  of  garlic, 
burning  with  a  bluish-white  flame,  which  deposits  metallic 
arsenic  in  the  form  of  a  black  spot  on  the  surface  of  a  cold 
plate  if  held  directly  in  the  flame. 

Reinsch's  test  consists  of  boiling  the  material  suspected  of 
containing  arsenic  with  hydrochloric  acid  and  copper  foil,  when, 
if  arsenic  is  present,  it  will  manifest  itself  in  the  form  of  a 
coating  of  gray  metallic  arsenic  upon  the  foil. 

♦Nascent  hydrogen  is  evolved  by  the  action  of  diluted  sulphuric  acid 
on  zinc. 


114  DENTAL   PATHOLOGY  AJSD  DENTAL   MEDICINE. 

Dental  Uses. — Arsenic  is  employed  in  dental  practice  for 
its  devitalizing  power  in  destroying  the  vitality  of  the  pulps  of 
teeth.  It  is  generally  combined  with  other  agents,  in  the  form 
of  paste  or  fibre,  for  this  purpose.  But  I  have  found  the  white 
arsenic  alone  to  act  very  happily  when  applied  to  the  pulp  and 
retained  by  a  small  pledget  of  cotton  which  had  been  'previously 
saturated  with  cocaine.  The  cavity  should  be  completely  se- 
cured, that  none  of  the  arsenic  come  in  contact  with  the  part 
outside  of  the  tooth. 

The  quantity  to  be  used  for  this  purpose  is  about  the  ^ /^^ 
of  a  grain,  and  the  time  required  is  usually  about  24  hours, 
though  there  are  instances  where  48  hours  or  more  are  required 
to  thoroughly  destroy  the  vitality. 

ZiNC^  Zn. 

Properties. — Zinc  is  one  of  the  metallic  elements — it  is 
very  hard,  has  a  bluish-white  color,  and  the  fresh  surface  has 
considerable  lustre,  but  is  soon  dulled,  from  the  facility  with 
which  it  oxidizes. 

Principal  Preparations: — 

Zinci  Oxidum.     Dose,  gr.  j-x,  insoluble  in  water. 

Zinci  Acetas.  Dose,  gr.  i/4-ij;  as  a  lotion,  gr.  ij  to  Sj  of 
water,  in  which  it  is  very  soluble. 

Zinci  Sulphas.  Dose  as  a  tonic  and  astringent,  gr.  Yio-j. 
As  an  emetic,  gr.  vj  in  §iv  of  water,  in  tablespoonful  doses,  re- 
peated every  few  minutes  until  emesis  takes  place. 

Zinci  Carbonas  Praecipitatus.  As  ointment,  or  dusted 
over  wounds  as  a  protection. 

Zinci  lodidi.    Dose,  gr.  ss-v,  in  the  form  of  a  syrup. 

Zinci  Chloridum,  tonic  and  escharotic.  Dose,  gr.  ss-ij,  well 
diluted. 

Zinci  Chloridum  Liquor,  solution  of  chloride  of  zinc,  1/2  to 
1  per  cent,  in  strength. 


TONICS.  115 

Physiological  Actions. — The  salts  of  zinc  are  more  or  less 
poisonous,  the  soluble  salts,  the  acetate,  sulphide,  and  chloride 
being"  corrosive  poisons.  In  small  doses  they  are  tonic  and 
astringent,  while  in  larger  quantities  they  are  strong  emetics. 

The  sulphate  is  a  specific  emetic,  acting  without  much 
depression. 

The  chloride  is  a  powerful  and  penetrating  escharotic.  It 
is  also  a  useful  deodorizer  and  disinfectant.  "When  applied 
to  malignant  and  indolent  ulcers,  it  promotes  healthy  granula- 
tions, and  when  topically  applied  it  not  only  destroys  the  dis- 
eased structure,  but  excites  a  new  and  healthy  action  of  sur- 
rounding parts." 

The  antidotes  for  zinc  poisoning  are,  the  white  of  an  egg, 
carbonate  of  soda,  magnesia,  etc. 

Dental  Uses. — In  dental  practice  the  chloride  of  zinc 
(ZnCl.J  is  a  valuable  agent.  It  is  employed  as  an  obtunding 
agent  for  sensitive  dentine — the  sensitive  surface  being  pre- 
viously bathed  with  chloroform,  which  will  modify  the  painful 
action  of  the  chloride.  It  has  also  been  employed  as  a  styptic 
to  arrest  superficial  hemorrhage  from  a  wound  of  the  gum 
during  the  filling  of  the  teeth.  It  induces  union  of  the  wounded 
parts  by  first  intention,  by  its  effect  upon  the  glutinous  matter, 
also  as  an  injection  for  chronic  alveolar  abscess,  and  in  diseases 
of  the  antrum  of  Highmore.  It  is  also  used  in  the  recession  of 
the  gum  and  the  absorption  of  the  alveolar  process  from  the 
necks  of  the  teeth.  The  application  can  be  conveniently  made 
by  means  of  a  piece  of  orange  wood,  so  shaped  as  to  permit  of 
its  being  introduced  beneath  the  gums. 

The  chloride  of  zinc,  in  solution,  is  also  used  as  one  of 
the  ingredients  of  the  filling  material  known  as  the  oxychloride 
of  zinc,  the  other  ingredient  being  the  oxide  of  zinc. 

The  combination  of  these  two  forms  of  zinc  makes  an  ex- 
cellent capping  material,  and  is  probably  one  of  the  best  mate- 
rials for  root  filling. 


116  DENTAL  PATHOLOGY  AND  DENTAL   MEDICINE. 

The  oxide  of  zinc,  ZnO,  is  sometimes  employed,  combined 
with  carbolic  acid,  in  the  form  of  a  paste,  for  capping  exposed 
pnlps;  it  is  also  one  of  the  ingredients  of  the  zinc  filling 
materials,  and  of  the  celluloid  base  of  artificial  teeth. 

The  sulphate  of  zinc,  ZnSO^THgO,  is  sometimes  employed 
in  disease  of  the  antrum  of  Highmore,  and  ulcerations  of  the 
mucous  membrane,  for  its  stimulant  and  astringent  properties. 

Sulphuric  Acid^  HgSO^. 

Properties. — Sulphuric  acid,  or  oil  of  vitriol,  is  a  dense, 
inodorous,  colorless,  oily,  and  corrosive  liquid.  It  consists  of 
not  less  than  96  per  cent,  sulphuric  anhydride  and  about  10 
per  cent,  of  water. 

Preparations: — 

Sulphuric  Acid.     Used  as  an  escharotic  or  caustic. 

Diluted  Sulphuric  Acid  (10  per  cent,  of  the  acid  to  90 
per  cent,  of  water).    Dose,  niv-xv,  well  diluted. 

Aromatic  Sulphuric  Acid  (Elixir  of  Vitriol).  Sulphuric 
acid  diluted  with  alcohol  and  flavored  with  ginger  and  cinna- 
mon (strength  20  per  cent.).     Dose,  Tltv-xxv,  well  diluted. 

Action. — The  action  of  sulphuric  acid  in  its  different  forms 
is  as  follows:  Aromatic  sulphuric  acid,  tonic  and  astringent; 
diluted  sulphuric  acid,  tonic,  astringent,  and  refrigerant  (in 
fevers) ;  sulphuric  acid,  escharotic. 

Treatment  of  Sulphuric  Acid  Poisoning. — Being  a  cor- 
rosive poison,  sulphuric  acid  causes  death  from  asphyxia  (the 
suspension  of  vital  phenomena,  from  the  non-oxygenation  of 
the  blood — an  excess  of  carbon  dioxide).  Administer  alkalies, 
as  washing  soda,  magnesia,  lime  water,  soapsuds,  etc.,  to  neu- 
tralize the  acid,  and  mucilaginous  drinks  freely,  to  protect  the 
mucous  membrane.  Stimulants,  opium,  aramonia  intraven- 
ously, to  combat  the  depressed  condition  of  the  vital  powers. 

Dental  Uses. — The  concentrated  sulphuric  acid  is  employed 
in  dental  practice  as  a  caustic;  in  the  laboratory,  in  a  diluted 


TONICS.  117 

state,  for  the  cleansing  of  metals  before  and  after  soldering 
("the  acid  bath").  It  is  also  used  in  the  manufacture  of 
pyroxylin — gun  cotton. 

Aromatic  sulphuric  acid  is  more  agreeable  for  use  in  the 
mouth,  while  its  action  resembles  that  of  diluted  sulphuric  acid. 
It  is  a  valuable  agent  in  the  treatment  of  pyorrhoea  alveolaris 
and  necrosis  of  the  maxillary  bones,  stimulating  the  parts  to 
healthy  action.  It  is  also  employed  in  the  treatment  of  chronic 
alveolar  abscesses,  in  combination  with  a  few  drops  of  tincture 
of  capsicum. 

Nitric  Acid,  HN0„. 

Properties. — Nitric  acid,  or  aqua  fortis,  is  a  highly  caustic 
liquid,  very  volatile,  its  fumes  being  corrosive  and  suffocating, 
and  in  the  pure  state  is  colorless  and  transparent,  but  that 
usually  found  in  shops  is  of  a  yellow  color,  owing  to  the  pres- 
ence of  nitric  peroxide.  Strong  nitric  acid  is  never  given  in- 
ternally; it  is  used  in  the  form  of  the  diluted  nitric  acid,  10 
per  cent,  absolute  acid.     Dose  lUiij-x,  well  diluted. 

Action. — Pure  nitric  acid  is  a  powerful  caustic  and  escha- 
rotic,  and  is  rarely  used  except  as  an  application  to  foul,  indo- 
lent ulcers,  or  to  warts.  The  diluted  acid  is  a  tonic,  alterative, 
and  refrigerant,  used  as  a  drink  in  fevers.  It  is,  as  are  most 
mineral  acids,  injurious  to  the  teeth;  hence,  care  should  be 
taken  in  its  use.  It  should  be  taken  through  a  glass  tube  or 
quill,  and  followed  by  an  alkaline  mouth  wash.  It  is  not  as 
agreeable  to  the  stomach  as  diluted  sulphuric  acid. 

The  antidotes  for  nitric  acid  poisoning  are  magnesia  or 
soap  and  mucilaginous  drinks. 

Dental  Uses. — ^Nitric  acid  is  employed  in  dental  practice 
as  a  caustic  for  malignant  ulcers  of  the  mouth,  and  has  been 
used  for  devitalizing  pulps  of  teeth  when  nearly  exposed  by 
mechanical  abrasion.  It  is  also  used  in  combination  with 
hydrochloric  acid  (aqua  regia)  as  a  solvent  for  gold. 


118  DENTAL  PATHOLOGY  AND  DENTAL   MEDICINE. 

Phosphoric  Acid,  HgPO^. 

Properties. — Phosphoric  acid  is  a  solid,  colorless  compound, 
soluble  in  water  and  vitrifiable  by  heat  (converted  into  glass). 
It  is  obtained  from  bones,  where  it  exists  in  combination  with 
lime.  Diluted  phosphoric  acid  is  the  form  in  which  phosphoric 
acid  is  usually  employed  in  medicine.  It  contains  10  per  cent, 
of  the  absolute  acid.    Dose,  "niv-xx. 

Action. — Phosphoric  acid  is  tonic  and  refrigerant,  and  in 
large  doses  an  irritant  poison.  It  has  been  employed  externally 
in  the  treatment  of  osseous  tumors  and  caries  of  the  bones. 

Glacial  phosphoric  acid,  HOPO-,  is  obtained  from  calcined 
bones.  They  are  first  treated  with  sulphuric  acid,  "which  pro- 
duces an  insoluble  superphosphate  of  lime,  then  dissolving  out 
the  latter  salt  and  saturating  it  with  carbonate  of  ammonia, 
which  generates  phosphate  of  ammonia  in  solution,  and,  finally, 
obtaining  the  phosphate  of  ammonia  by  evaporating  t^  dryness, 
and  then  igniting  it  in  a  platinum  crucible.  The  ammonia  and 
all  of  the  water,  except  one  equivalent  for  each  equivalent  of 
the  acid,  are  driven  off,  and  the  glacial  phosphoric  acid  remains. 
It  is  a  white,  transparent,  fusible  solid,  generally  in  the  form 
of  sticks,  inodorous,  and  sour  to  the  taste.  It  slowly  deliquesces, 
and  is  sparingly  soluble  in  water,  but  freely  soluble  in  alcohol."* 

Dental  Uses. — Phosphoric  acid  has  been  employed  in  dental 
practice  as  a  local  treatment  of  osseous  tumors  and  caries  of 
the  maxillary  bones. 

Glacial  phosphoric  acid  is  employed  as  one  of  the  ingre- 
dients of  the  plastic  filling  material,  known  as  oxyphosphate  of 
zinc,  the  other  ingredient  being  the  white  oxide  of  zinc. 

Hydrochloric  Acid,  HCl. 
Properties. — Hydrochloric  or  muriatic  acid  is  nearly  color- 
less when  pure,  but  that  usually  found  in  the  shops  is  of  a  pale 
yellow  color,  being  contaminated  with  chlorine,  iron,  and  other 

*Gorgas'    "Dental   Medicine." 


ANTIPYRETICS.  119 

substances.  It  is  volatile,  emitting  a  dense  white  and  suffocat- 
ing vapor;  taste  very  acid  and  caustic. 

Actions. — Hydrochloric  acid  is  caustic,  escharotic,  and  dis- 
infectant. The  diluted  acid  administered  internally  is  tonic, 
refrigerant,  and  astringent. 

Diluted  Hydrochloric  Acid  (ten  per  cent,  solution  of 
absolute  acid  and  water).     Dose,  TTLv-xx. 

Dental  Uses. — It  is  sometimes  a  useful  application  for 
treatment  of  ulceration  and  inflammation  of  the  mucous  mem- 
brane and  gums.  "The  strong  acid  is  employed  in  the  labora- 
tory for  dissolving  zinc,  in  the  preparation  of  a  flux  for  solder- 
ing certain  metals." 

SEDATIVES. 

Sedatives  are  agents  which  exert  a  soothing  influence — -that 
is,  diminish  pain — by  lessening  the  functional  activity  of 
organs. 

The  principal  agents  of  this  class  are  opium  and  aconite 
(see  Anodynes),  digitalis  (see  Tonics),  alcohol  (see  Stimu- 
lants), chloroform   (see  Anesthetics),  etc. 

ANTIPYRETICS. 

Antipyretics  are  agents  which  reduce  the  temperature  of 
fever.  They  act  either  by  lessening  heat  production  or  by 
radiation  of  heat. 

The  most  prominent  of  this  class  are  antipyrine,  quinine 
(see  Tonics),  aconite,  alcohol  (by  increasing  heat  radiation), 
also  cold  bath,  ice  to  the  body,  etc. 

Antipyrine,  C2oIIj^gN402. 

Derivation. — Antipyrine  is  an  alkaliodal  product  of  the 
destructive  distillation  of  coal-tar  oil. 

Properties.— It  is  a  whitish,  crystalline  powder,  soluble  in 
water   (one-half  its  weight  of  hot  and  its  own  weight  of  cold 


120  DENTAL  PATHOLOGY  AND  DENTAL   MEDICINE. 

water) ;  less  soluble  in  alcohol,  chloroform,  and  ether ;  is  slight- 
ly bitter  and  odorless.  It  may  be  administered  hypodermically ; 
IS  non-irritant  to  the  stomach  or  the  tissues.  When  combined 
with  ferric  chloride  it  gives  a  bright-red' color,  and  with  nitric 
acid  a  beautiful  green  color. 

Actions. — Antipyrine  is  a  powerful  and  popular  antipyretic, 
a  general  anodyne,  haemostatic,  and  also  possesses  mild  anes- 
thetic and  hypnotic  powers.  A  full  medicinal  dose  (gr.  xxx) 
produces  a  stimulant  stage  of  short  duration,  which  is  soon 
followed  by  profuse  sweating,  coolness  of  the  surface,  slowed 
pulse,  and  more  or  less  depression.  The  temperature  in  fevers 
is  reduced  from  2  to  10  degrees  in  from  1  to  5  hours,  according 
to  the  size  and  continuance  of  the  dose.  In  health  the  reduction 
of  the  temperature  is  very  slight,  and  it  gives  rise  to  slight 
nausea  and  depression.  It  is  eliminated  by  the  kidneys,  appear- 
ing in  the  urine  a  few  hours  after  taking.  ♦ 

"In  toxic  doses  its  principal  influence  is  exerted  upon  the 
blood,  altering  the  shape  of  the  red  blood  corpuscles,  separating 
the  hsematin,  and  causing  decomposition  of  that  fluid."* 

Dose,  for  adult,  gr.  v-xxx;  children,  gr.  j-x. 

Dental  Uses. — Antipyrine  may  be  employed  in  dental  prac- 
tice for  its  haemostatic,  anesthetic,  and  anodyne  powers. 

lEEITANTS. 

Irritants  are  agents  which  produce  more  or  less  vascular  ex- 
citement or  inflammation.  They  may  be  either  chemical,  me- 
chanical, or  nervous. 

Chemical  irritants  are  those  which  act  by  virtue  of  their 
atfinity  for  organic  tissue,  exciting  the  action  of  the  capillaries, 
and  causing  an  afflux  of  vascular  and  nervous  power  to  the 
part   to   which   they   are   applied.      Included   in   this   class   are 


♦Potter's   "Materia   Medica." 


IRRITANTS.  121 

iodine,  capsicum,  (see  Stimulants),  turpentine,  ammonia  (see 
Stimulants),  etc. 

Mechanical  irritants  are  agents  or  means  that  cause  lesions 
or  inflammation  by  mechanical  operation.  Filling  material  or 
other  foreign  substances  being  forced  through  the  apical  fora- 
men of  the  root  of  a  tooth  will  cause  sufficient  irritation  to 
produce  an  abscess;  and  cuts,  contusions,  etc.,  are  included 
in  this  class. 

Nervous  irritants  act  through  the  medium  of  the  nerves, 
as   nervous   shock,   depression,   or   sympathetic   inflammation. 

Iodine. 

Derivation. — Iodine  is  obtained  principally  from  marine 
plants,  though  it  occurs  in  cod-liver  oil  and  shell-fish  to  a 
limited  extent. 

Properties. — ^Iodine  is  -a  non-metallic  element,  is  usually  in 
the  form  of  bluish-black  crystalline  plates  or  scales,  having  a 
metallic  lustre,  a  peculiar  odor,  hot,  acrid  taste,  and  is  of 
neutral  reaction.  It  volatilizes  at  a  low  temperature,  giving  off 
a  beautiful  purple  vapor,  is  slightly  soluble  in  water  (1  in 
TOGO),  readily  soluble  in  alcohol  and  ether  (1  in  12),  also  in  a 
solution. of  chloride  of  sodium  and  iodide  of  potassium. 

Principal  Preparations : — 

Tincture  of  Iodine,  8  per  cent,  in  alcohol.    Dose,  lUj-v. 

Compound  Tincture  of  Iodine  (iodine,  5  per  cent.,  potas- 
sium iodide,  KI,  10  per  cent.,  and  water  85  per  cent.).  Dose, 
nij-x  diluted. 

Potassium  Iodide.    Dose,  gr.  v-xxx. 

Iodoform,  CHI3.    Dose,  gr.  j-v,  in  pill  form. 

Actions. — Iodine  in  its  elementary  state  is  an  irritant  to 
the  skin,  and  is  much  used  in  the  form  of  tincture  to  produce 
counter-irritation. 

Internally  in  small  doses  it  is  a  stimulant  and  tonic;  it 
excites  a  sensation  of  heat  or  burning  in  the  stomach,  and  in 


122  DENTAL  PATHOLOGY  AND  DENTAL  MEDICINE. 

large  doses  acts  as  an  irritant  poison.  If  continued  for  any 
length  of  time,  iodine  induces  great  waste  and  rapid  elimina- 
tion of  waste  products,  causing  anaemia  and  depression. 

The  local  irritant  effect  is  diminished  when  combined  with 
potassium;  hence,  potassium  iodide  (aqueous  solution  of  potassa 
and  iodine)  is  usually  employed  for  internal  use,  which  allows 
the  administration  of  larger  doses  and  for  a  greater  length  of 
time. 

Toxicology. — The  antidote  for  iodine  is  starch,  forming  an 
iodized  starch,  which  should  then  be  evacuated  from  the 
stomach. 

Colorless  Iodine. — There  are  a  number  of  methods  for 
bleaching  iodine;  among  them  are  the  following:  1st.  Add  to 
a  drachm  of  tincture  of  iodine  six  ounces  of  hot  water  and 
twelve  grains  of  phenol;  stir  with  a  glass  rod.  2d.  Iodine  is 
bleached  by  mixing  with  carbolic  acid;  this,  carbolate  of  iodine, 
combines  all  the  advantages  of  both  agents. 

Dental  Uses. — Iodine  is  a  very  valuable  agent  in  dental 
practice,  the  tincture  being  employed  locally  in  the  treatment 
of  periostitis,  inflarmnation  and  ulceration  of  the  gums,  fun- 
gous growths,  suppurating  pulps  of  teeth,  alveolar  abscess,  and 
for  ulcerations  of  the  mucous  membrane;  it  is  often  combined 
with  carbolic  acid,  and  for  dental  periostitis  it  is  generally 
combined  with  tincture  of  aconite;  this  combination  forms  an 
excellent  treatment  for  the  incipient  stages  of  this  affection,  as 
well  as  those  of  alveolar  abscesses. 

Turpentine. 

Derivation. — Turpentine  is  a  concrete,  oleo-resinous  exuda- 
tion from  various  species  of  pine,  but  principally  from  the 
"yellow  pine." 

Properties. — Turpentine  is  in  the  form  of  tough,  yellowish 
masses,  more  or  less  transparent,  inflammable,  having  a  strong, 
unpleasant  odor,  and  warm,  pungent  taste. 


ASTRINGENTS.  123 

It  is  composed  entirely  of  resin  and  the  essential  oil  known 
as  oil  of  turpentine,  Cj^H^gO.  It  is  soluble  in  alcohol.  The 
oil  is  the  form  mainly  used. 

Actions. — Turpentine  is  a  stimulant,  diuretic,  antispas- 
modic, and  rubefacient  (counter-irritant),  and  antiseptic  ex- 
ternally. 

Principal  Preparations : — 

Oil  of  Turpentine,  Spirits  of  Turpentine,  a  volatile  oil  dis- 
tilled from  turpentine.  Dose,  TTtv-xv  in  emulsion  as  a  stimulant. 

Turpentine  Liniment. — Resin  cerate  (a  composition  of 
wax,  oil,  or  lard),  65  per  cent.,  oil  of  turpentine,  35  per  cent. 

Pitch  is  a  resinous  exudation  from  the  stem  of  certain  pine, 
fir,  and  spruce  trees.  It  melts  at  the  boiling  point  of  water,  and 
softens  by  the  heat  of  the  human  body.  It  is  of  a  dark-brown 
color,  and  possesses  a  well-known  odor  and  taste.  It  is  used 
principally  as  the  base  of  plasters. 

Dental  Uses. — Turpentine  may  be  used  in  dental  practice 
for  its  rubefacient  and  antiseptic  properties. 

ASTRINGENTS. 

Astringents  are  agents  which  produce  contraction  and  con- 
densation of  organic  tissues,  with  a  tendency  to  remove  morbid 
affections,  arrest  hemorrhage  and  excessive  secretions  from  the 
mucous  membrane.  They  are  divided  into  two  classes,  known 
as  vegetable  and  mineral. 

The  principal  vegetable  astringents  are  tannic  acid  and 
gallic  acid,  the  chief  elements  of  these  being  tannin,  while  the 
mineral  astringents  are  persalts  of  iron  (see  Tonics),  alum, 
sulphuric  acid,  nitric  acid,  etc. 

Tannic  Acid,  02^11220^^. 

Derivation. — Tannic  acid  is  obtained  from  nut  galls.  Galls 
are  the  excrescence  on  the  twigs  of  the  Dyer's  oak,  grown  in 


124  DEXTAL  PATHOLOGY  AND  DEKTAL   MEDICINE. 

Asia  Minor  and  Persia,  caused  by  the  punctures  and  deposited 
ova  (egg)  of  an  insect. 

Properties. — Tannic  acid  is  obtained  in  the  form  of  thin, 
yellowish  crystals,  inodorous,  very  soluble  in  water,  less  so  in 
alcohol  and  ether. 

Actions. — Tannic  acid  is  the  most  powerful  of  all  vegetable 
astringents  and  styptics.  It  is  especially  active  upon  albumin, 
gelatin,  and  fibrin,  forming  therewith  insoluble  tannates,  thus 
protecting  the  parts  beneath  until  resolution  occurs.  Dose, 
gr.  j-xx,  in  pill. 

Dental  Uses. — Tannic  acid  is  a  very  valuable  agent  to  the 
dental  practitioner.  It  is  used  locally  in  the  treatment  of 
hemorrhage  following  the  extraction  of  teeth,  wounds  of  the 
mucous  membrane,  fungous  growths  of  the  tooth  pulp,  hyper- 
trophy of  the -gums,  and  to  many  it  has  proven  beneficial  in  the 
treatment  of  sensitive  dentine,  a  strong  solution  of  tannin  being 
mixed  with  alcohol.  In  mercurial  salivation,  the  powdered  tan- 
nic acid,  moistened  with  water,  will  check  the  tendency  to 
absorption  and  the  consequent  loosening  of  the  teeth,  and  will 
render  the  gums  firmer  and  more  comfortable. 

Glycerite  of  Tannic  Acid  (tannin,  Sij;  glycerin,  Sviij), 
for  external  use. 

Ointment  of  Tannic  Acid  (tannin,  3j;  lard,  Sj),  for  appli- 
cation to  ulcers,  etc. 

Gallic  Acid,  C^HgOg. 

Derivation. — Gallic  acid  is  prepared  from  nutgalls.  The 
powdered  galls,  in  water,  are  left  to  the  action  of  the  atmos- 
phere, when  the  acid,  in  the  form  of  fine,  almost  colorless,  crys- 
tals are  deposited. 

Properties. — Gallic  acid  is  obtained  in  the  form  of  very 
fine,  silky,  and  almost  colorless  crystals.  It  is  slightly  soluble 
in  cold  water  (100  parts),  and  rapidly  so  in  hot  water,  glycerine, 
or  alcohol.    It  has  a  slightly  acid  and  astringent  taste. 


ASTRINGENTS.  125 

Action. — Gallic  acid  is  a  powerful  astringent,  styptic,  and 
disinfectant.  It  is  given  directly  for  internal  hemorrhage  pro- 
fuse perspiration  (night  sweats),  and  excessive  expectorations 
of  phthisis  and  chronic  diarrhoea.    Dose,  gr.  v-xx,  in  pill  form. 

Dental  Uses. — in  dental  practice  gallic  acid  may  be  used 
as  a  styptic  in  superficial  hemorrhages;  it  is  not  so  efficient, 
however,  as  tannic  acid.  It  is  employed  in  the  form  of  a  gargle, 
in  acute  inflammation  of  the  mucous  membrane,  etc.  For 
hemorrhage  following  extraction  of  teeth.  Dr.  Bartholomew 
claims  that  a  tea  spoonful  of  gallic  acid  in  a  glass  of  water,  in- 
ternally administered,  is  very  efficacious. 

Alum. 

Source. — Alum  is  found  native  in  Italy,  in  the  neighbor- 
hood of  volcanoes.  It  is  also  obtained  from  aluminous  slate  or 
shale  by  roasting  and  exposure  to  the  air. 

Formula. — The  official  alum  (potassic-aluminic-sulphate) 
has  the  formula  K2AL24SO4+24H2O.  Dried  or  "burnt  alum" 
has  the  water  of  crystallization,  24II2O,  driven  off  by  gentle 
heating,  which  leaves  it  in  the  form  of  a  soft,  white  powder. 

Properties. — Alum  is  a  white,  transparent  salt,  crystallizing 
easily  in  octahedrons  (having  eight  equal  and  equalateral  tri- 
angles). It  dissolves  easily  in  hot  water,  and  by  about  fifteen 
times  its  weight  in  cold  water;  is  insoluble  in  alcohol.  It  pos- 
sesses an  astringent  and  sweetish  taste. 

Actions. — When  taken  internally  in  large  doses,  it  causes 
vomiting,  purging,  and  inflammation  of  the  gastro-mucous 
membrane.  As  an  emetic,  powdered  alum,  in  teaspoonful  doses 
is  very  efficient.  Applied  locally,  it  is  an  excellent  astringent  to 
relaxed  or  bleeding  parts.  Dose,  in  powder  or  solution,  gr. 
x-xl  (2®). 

Dental  Uses. — In  dental  practice,  alum  is  employed  as  a 
styptic  in  alveolar  hemorrhage,  superficial  hemorrhage  of  the 
mucous  membrane,  ulcers  of  the  mouth,  etc.    It  also  serves  an 


126  DENTAL   PATHOLOGY  AND  DEXTAL   MEDICINE. 

excellent  purpose  as  a  gargle  in  ulceration  and  sponginess  of 
the  gums. 

STYPTICS  AND  HEMOSTATICS. 

Styptics  are  agents  which  arrest  hemorrhage  by  local  appli- 
cation. They  are  divided  into  chemical  and  mechanical,  ac- 
cording to  their  action. 

Chemical  styptics  coagulate  the  exuding  blood,  and  at  the 
same  time  stimulate  the  tissues  to  contraction. 

The  principal  members  of  this  class  are,  tannic  and  gallic 
acids  (see  Astringents),  persulphate  of  iron — solution,  subsul- 
phate  of  iron — powdered  (see  Tonics),  alum  (see  Astringents), 
and  adrenalin. 

Mechanical  styptics  are  agents  which  promote  clot  forma- 
tions in  the  mouths  of  bleeding  vessels.  They  retard  the  flow 
by  detaining  the  blood  in  their  meshes,  or  absorb  it^  until  it 
coagulates. 

The  principal  mechanical  styptics  are  spider's  web,  plas- 
ter-of -Paris,  sandarach  varnish,  cotton,  etc. 

Adrenalin. 

Derivation. — Adrenalin  is  the  active  principle  of  the 
adrenal  or  suprarenal  gland.  Adrenalin  chloride,  1 :  1000,  is  a 
definite  product,  composed  of  1  part  adrenalin  with  999  parts 
normal  saline  solution,  and  may  be  diluted  to  any  degree  desired 
by  the  adding  of  this  solution.  This  preparation  is  practically 
permanent  if  kept  in  well  stoppered  bottles.  Under  continued 
exposure  to  air  the  liquid  becomes  brown  in  color  and  a  sedi- 
ment is  thrown  down,  when  it  should  be  discarded.  The  raanu- 
facturers  say  that  adrenalin  is  about  a  thousand  times  as  pow- 
erful as  adrenal  or  suprarenal  gland,  making  the  1 :  1000  solu- 
tion of  the  chloride  approximately  the  same  strength  of  the 
original  gland,  but  freed  from  all  inert  matter. 

Dental  Uses. — The  adrenalin  chloride  solution,  applied 
locally  is  an  excellent   styptic,   and   astringent.     Its   action   is 


ESCilAROTlGS  OR  CAUSTICS.  127 

local  upon  the  muscular  tissue  of  the  small  blood  vessels.  It 
does  not  coagulate  albumen.  Its  use  is  indicated  in  the  treat- 
ment of  persistent  hemorrhage  following  the  extraction  of  a 
tooth,  or  the  removal  of  a  pulp;  and  in  the  fitting  and  setting 
of  crowns,  etc.,  to  render  the  field  bloodless.  Adrenalin  has 
more  recently  been  recommended  for  the  extirpation  of  pulps, 
but  extended  clinical  experience  must  determine  just  what  value 
it  has  in  this  direction. 

Hemostatics  are  agents  capable  of  arresting  hemorrhage 
by  internal  administration,  such  as  ergot,  antipyrine  (see  As- 
tringents), the  diluted  m.ineral  acids  (see  Tonics),  etc. 

Ergot. 

Source. — Ergot  is  obtained  from  a  parasitic  fungi  replacing 
the  grain  of  rye.  It  is  a  diseased  state  of  the  grain,  occasioned 
probably  by  a  hot  summer  succeeding  a  rainy  spring.  Corn 
ergot  is  obtained  from  a  similar  growth  upon  the  Indian  corn. 

Principal  Preparations : — 

Fluid  Extract  of  Ergot.    Dose,  3ss-ij. 

Extract  of  Ergot.    Dose,  gr.  j-xx. 

Medical  Properties  and  Actions. — Ergot  is  a  hemo- 
static, aiding  coagulation  by  slowing  the  blood  current.  It  is 
also  used  to  stimulate  the  contraction  of  unstriped  muscular 
fibre,  particularly  those  of  the  uterus,  causing  continuous  labor 
pains.  It  has  been  much  used  for  this  purpose  in  obstetrics, 
and  very  often  injuriously,  causing  laceration  of  the  perineum 
and  paralysis  of  the  foetal  heart,  the  natural  intermitting  con- 
traction being  the  most  desirable. 

Dental  Uses. — Ergot  may  be  used  in  dental  practice  for  its 
hemostatic     properties  in  alveolar  or  other  hemorrhages. 

ESCHAROTICS  OR  CAUSTICS. 

Escharotics  or  caustics  are  agents  which  are  capable  of  de- 
stroying the  life  of  the  tissue  with  which  they  come  in  contact, 
producing  an  eschar  or  sloughing  of  the  tissue.     Fire  itself  is 


128  DENTAL  PATHOLOGY  AND  DENTAL  MEDICINE. 

the  actual  cautery,  while  the  potential  cautery  (caustic  sub- 
stances) is  reijresented  by  silver  nitrate,  arsenious  acid  (see 
Tonics),  carbolic  acid,  zinc  chloride  (see  Tonics),  and  the 
mineral  acids  (see  Tonics),  etc. 

Nitrate  of  Silver^  AgNOg. 

Derivation. — ^Nitrate  of  silver,  or  "lunar  caustic,"  is  made 
by  dissolving  silver  in  nitric  acid,  and  evaporating  the  solution. 
The  reation  being  Ag3+4H]Sr03=3AgN03+2H20+NO. 

Properties. — Nitrate  of  silver  is  in  the  form  of  colorless, 
shining  crystals,  but  is  readily  blackened  by  mixing  with  or- 
ganic matter  or  by  exposure  to  the  light,  is  very  soluble  in 
water,  and  has  a  strong  metallic  and  styptic  taste.  It  is  often 
cast  in  sticks,  by  first  being  melted  (fusing  at  426'  F.)  and 
then  poured  into  suitable  moulds. 

Actions. — Nitrate  of  silver  is  a  powerful  caustic  and  astrin- 
gent, a  heart  and  nerve  stimulant,  antispasmodic  and  sedative. 
When  applied  locally  to  the  mucous  membrane,  ulcers,  etc.,  it 
first  turns  the  surface  white,  owing  to  its  union  with  the  coagu- 
lated albumin,  but  finally  turns  to  a  black  color,  which  is  due 
to  the  partial  reduction  of  the  silver  by  the  sulphuretted  hydro- 
gen contained  in  the  atmosphere.  Continued  use  of  nitrate  of 
silver  will  cause  a  peculiar  blue  line  in  the  gums,  similar  to 
that  from  lead  poisoning;  this  is  followed  by  a  blue  appearance 
of  the  skin.  The  remedy  should  be  discontinued  at  once  when 
this  discoloration  is  observed. 

Dose  of  nitrate  of  silver,  gr.  y^  gradually  increased  to 
gr.  3,  in  pill  form.  Never  should  be  given  with  tannin  or  a 
vegetable  extract ;  an  explosive  compound  may  result.  .  The 
fused  or  solid  form  is  used  externally. 

The  antidote  for  nitrate  of  silver  is  chloride  of  sodium 
(common  salt)  freely;  it  precipitates  it  in  the  insoluble  chlo- 
ride of  silver;  also  acts  as  an  emetic. 


ESCI-IAROTICS  OR  CAUSTICS.  129 

Dental  Uses. — Nitrate  of  silver  is  employed  in  dental  prac- 
tice for  obtunding  sensitive  dentine,  especially  where  the  cause 
is  mechanical  abrasion,  or  from  the  fracture  of  a  tooth,  expos- 
ing the  healthy  and  sensitive  dentine,  the  stick  form  being  em- 
ployed, or  the  end  of  a  silver  wire  may  be  immersed  in  nitric 
acid  and  carefully  applied.  It  is  also  a  valuable  application  for 
ulcerated  conditions  of  the  mucous  membrane  of  the  mouth, 
also  as  a  treatment  for  caries  in  deciduous  teeth. 

Carbolic  Acid^  CgH^O. 

Derivation. — Carbolic  acid,  phenylic  alcohol  or  phenol,  is 
obtained  as  an  alcoholic  product  of  the  distillation  of  coal  tar, 
between  the  temperatures  of  338°  and  370°  F.  Carbolic  acid, 
though  the  universal  name,  is  inappropriate.  It  does  not  be- 
long to  the  acid  series  (it  will  not  turn  blue  litmus  paper  red), 
being  neutral  in  its  reaction. 

Properties. — Carbolic  acid,  when  pure,  is  in  the  form  of 
colorless  or  pinkish  acicular  (needle-like)  crystals.  It  becomes 
an  oily  liquid  at  95°  F.,  or,  if  exposed  to  the  air,  the  crystals 
readily  absorb  moisture  and  are  thus  liquefied.  Five  per  cent, 
of  water  liquefies  it;  any  further  addition  simply  forms  a 
mechanical  mixture.  It  is  freely  soluble  in  alcohol,  ether,  chlo- 
roform, glycerine,  and  the  essential  oils.  It  has  a  strong  aro- 
matic odor  and  taste,  resembling  creasote  somewhat. 

Actions. — Carbolic  acid  in  its  pure  state  is  escharotic;  when 
diluted,  it  is  a  powerful  antiseptic,  germacide,  rubefacient,  and 
is  a  violent  poison;  internally,  it  is  a  sedative  and  carminative, 
allaying  vomiting  and  gastric  irritability. 

It  resembles  creasote  closely  in  many  of  its  medicinal  prop- 
erties, but  is  probably  more  efficacious,  and  its  odor  is  surely 
less  objectionable. 

Dose,  gr.  y^,  for  relief  of  nausea,  etc. 

Dental  Uses. — Carbolic  acid  is  a  valuable  agent  in  dental 
therapeutics,  it  being  one  of  the  best  escharotics,  styptics,  anti- 


130  DENTAL  PATHOLOGY  AND  DENTAL   MEDICINE. 

septics,  sedatives,  etc.  It  is  used  to  obtund  sensitive  dentine, 
to  relieve  odontalgia,  when  caused  by  the  exposure  of  the  tooth 
pulp,  by  applying  it  to  the  exposed  surface;  it  arrests  putrefac- 
tive changes,  is  a  valuable  agent  in  the  treatment  of  alveolar 
abscess;  is  also  used  to  bathe  cavities  in  the  teeth,  both  for  its 
obtunding  effect  upon  the  sensitive  dentine  and  to  destroy  any 
low  organisms  that  may  be  in  the  softened  dentine. 

In  a  form  known  as  phenol  sodique,  carbolic  acid  is 
very  useful  as  a  styptic  for  the  treatment  of  superficial  hemor- 
rhage after  the  extraction  of  teeth,  and  forms  an  excellent  anti- 
septic mouth-wash. 

"Combined  with  glycerine  (1  part  to  12  of  glycerine)   it  will 

stimulate  the  mucous  secretion,  and  hence  has  been  applied  to 

the  palate,  in  cases  of  deficiency  of  this  secretion,  to  promote 

the  suction  of  the  upper  dentures."* 

• 
Acetic  Acid^  C^Kfi^. 

Derivation. — Acetic  acid  is  produced  from  wood  by  de- 
structive distillation. 

Properties  and  Actions. — The  purified  acid  contains  about 
28  per  cent,  of  anhydrous  acetic  acid.  The  dikited  acid,  the 
only  form  employed  internally,  is  composed  of  one  part  acetic 
acid  to  seven  parts  distilled  water. 

It  is  a  stimulant,  astringent,  diaphoretic,  escharotic,  etc. 
The  strong  acid,  when  applied  to  the  skin,  causes  considerable 
redness  and  pain,  which  rapidly  results  in  a  blister  (vesication). 

Dose. — Acetic  acid,  dilute,  3j-ij. 

Therapeutic  Uses. — Acetic  acid  is  sometimes  employed  in 
fevers,  night  sweats,  hemorrhage  of  the  lungs  or  stomach.  Ex- 
ternally, the  strong  acid  is  used  in  the  treatment  of  cancer, 
corns,  warts,  or  fungous  growths.  The  dilute  acid  is  sometimes 
employed  externally  to  gangrene,  ulcers,  and  sprains  or  bruises. 

*Pi-of.  Gorgas. 


ANTIZYMOTICS.  131 

Dental  Uses. — Acetic  acid  is  sometimes  applied  to  indolent 
ulcers  of  the  month,  and  to  fungus  growths  of  gum  or  dental 
pulp ;  for  the  latter  the  concentrated  form  is  employed.  Gorgas 
gives  the  following  formula  for  indolent  ulcers,  cancrum  oris, 
etc. :  Acetic  acid  three  fluid  ounces  to  distilled  water  five  fluid 
ounces;  apply  with  camel's-hair  brush. 

Trichloracetic  Acid. 

Derivation. — Trichloracetic  acid  is  formed  from  acetic  acid, 
three  atoms  of  the  hydrogen  of  which  is,  in  the  new  acid,  re- 
placed by  chlorine.  It  is  one  of  a  group  of  three  acids,  having 
similar  properties;  the  difference  in  their  composition  is  due 
to  the  proportion  of  chlorine  they  contain.  The  others  referred 
to  are  monochloracetic  and  dichloracetic  acids. 

Properties  and  Actions. — Trichloracetic  acid  is  in  the 
form  of  colorless,  deliquescent  crystals,  having  an  agreeable 
odor,  and  is  readily  soluble  in  water  and  alcohol.  Its  concen- 
trated solutions  are  powerful  caustics,  while  the  weaker  solu- 
tions make  a  good  antiseptic. 

Therapeutic  Uses. — As  an  antiseptic  it  is  used  in  putrid 
and  indolent  wounds  and  erysipelas.  Diluted  with  water  to  a 
3  per  cent,  strength  it  is  an  effective  stimulant  and  astringent. 

Dental  Uses. — It  is  used  in  dental  practice  as  an  escha- 
rotic;  10  per  cent,  solution  is  often  employed  in  the  treatment 
of  pyorrhoea  alveolar  is,  acting,  it  is  claimed,  as  a  solvent  on 
calculi  upon  the  roots  of  teeth.  A  one  per  cent,  solution  is 
reconunened  as  a  mouth-wash,  owing  to  its  astringent  and 
stimulating  qualities. 

ANTIZYMOTICS. 

Antizymotics  are  agents  which  arrest  or  prevent  fermenta- 
tive processes;  they  are  divided  into  antiseptics  and  disin- 
fectants. 


132  DENTAL  PATHOLOGY  AND  DENTAL  MEDICINE. 

Antiseptics  are  those  agents  whicli  prevent  or  retard  septic 
decomposition,  either  by  destroying  the  bacteria  upon  which 
putrefaction  depends,  or  by  arresting  their  development. 

The  most  important  of  this  group  are  bichloride  of  mer- 
cury, peroxide  of  hydrogen,  carbolic  acid,  (see  Escharotics),. 
potassium  permanganate,  iodoform,  phenal  sodique,  alcohol, 
eucalyptol,  etc. 

Disinfectants  are  those  agents  which  destroy  the  germs  of 
infectious  diseases. 

The  principal  members  of  this  group  are  carbolic  acid  (see 
Escharotics),  zinc  chloride  (see  Tonics,  Zinc),  potassium  per- 
manganate, iodine  (see  Irritants),  aromatic  sulphuric  acid  (see 
Tonics,  Sulphuric  Acid). 

Bichloride  of  Mercury^  HgCl2. 
Derivation. — Bichloride   of   mercury,   mercuric   chloride,   or 
"corrosive  sublimate,"  is  obtained  by  distilling*  a  mixture  of 
sodium  chloride  and  mercuric  sulphate;  a  double  decomposition 
takes  place,  forming  mercuric  chloride  and  sodium  sulphate. 

Properties. — Bichloride  of  mercury  is  in  the  form  of  col- 
orless crystalline  masses.  It  is  inodorous,  fusible,  soluble  in 
16  parts  of  water,  7  parts  of  alcohol  and  ether,  and  has  an  acrid, 
styptic  taste. 

Actions. — Bichloride  of  mercury  is  one  of  the  most  active 
salts  of  mercury.  It  is  one  of  the  most  efficient  of  all  the  anti- 
zymotics  in  the  strfength  of  1  part  to  2000  parts  of  water.  It  is 
internally  employed  in  chronic  diarrhoea,  dysentery,  and 
syphilis. 

Dose,  gr.  Vsq-Vio  i^  piU  form. 

Antidotes  to  bichloride  of  mercury  are  albumin,  wheat 
flour,  milk,  etc. 

♦The  double  process  of  vaporization  and  condensation  of  the  vapor. 


ANTIZYMOTICS.  133 

Dental  Uses. — For  prophylactic  treatment  of  the  oral 
cavity,  particularly  of  the  teeth,  bichloride  of  mercury,  1  to 
10,000,  is  most  effective.  It  should  be  carefully  used,  however, 
on  account  of  its  poisonous  character. 

It  is  also  used  extensively  in  dental  practice,  in  treatment 
of  alveolar  abscesses,  and  in  diseases  of  the  antrum  of  High- 
more,  in  a  solution  of  1  to  2000,  to  1  to  5000. 

Peroxide  of  Hydrogen^  112^^2- 
Derivation. — Peroxide  of  hydrogen  is  obtained  by  combin- 
ing  an   extra   molecule   of   oxygen   with   hydrogen    monoxide, 
H^O  (water),  the  result  being  a  water-like  liquid,  H2O2.     "As 
when  barium  dioxide  is  dissolved  in  dilute  hydrochloric  acid : — 

BaO^+SHCl+H^O-BaCl^+H^O-fH^O^."* 

Properties. — Peroxide  of  hydrogen  is  in  the  form  of  a  col- 
orless, transparent  liquid,  is  inodorous,  and  almost  tasteless. 

Actions. — Peroxide  of  hydrogen  is  one  of  the  most  efficient 
and  at  the  same  time  the  least  harmful  of  all  antiseptics  and 
disinfectants.  The  second  molecule  of  oxygen,  spoken  of  above, 
is  very  loosely  combined,  and  the  mixture  is  always  on  a  strain 
to  break  up  into  water  and  oxygen;  for  this  reason  it  should 
be  kept  in  a  cool  and  dark  place,  and  it  is  owing  to  this 
fact  (that  peroxide  of  hydrogen  generates  "ozone,"  O3)  that  pus 
and  the  bacteria  of  diseased  surfaces,  when  treated  with  this 
agent,  are  at  once  destroyed.  "As  soon  as  ozone  has  accom- 
plished its  cleansing  effects  upon  the  infected  surface,  it  is 
readily  transformed  into  ordinary  oxygen,  owing  to  its  insta- 
bility." It  is  employed  as  an  internal  remedy  in  fevers,  whoop- 
ing cough,  bronchitis,  consumption  or  phthisis,  diphtheria,  dys- 
pepsia, catarrh  of  the  stomach,  etc. 

LfOcally  Employed. — Peroxide  of  hydrogen  may  be  em- 
ployed for  its  antiseptic  and  pus-destroying  properties  in  the 

*Leffmann's  "Chemistry." 


134  DENTAL  PATHOLOGY  AND  DENTAL  MEDICINE. 

treatment  of  abscesses,  ulcers,  carbuncles,  wounds,  both  fresh 
and  putrid,  catarrh  of  the  nose,  hay  fever,  diphtheria,  etc.  It 
is  also  the  base  of  most  hair-bleaching  solutions. 

Dose  of  peroxide  of  hydrogen,  3ss-ij. 

Dental  Uses. — It  is  one  of  the  most  valuable  remedies  in 
dental  therapeutics,  being  especially  valuable  as  a  cleansing 
agent,  and  is  employed  also  in  the  treatment  of  alveolar 
abscesses,  pyorrhoea  alveolaris,  inflammation  and  ulceration  of 
the  oral  mucous  membrane,  fungous  growths,  etc. 

Pyrozone. 

Derivation. — ^Pyrozone  solutions  are  aqueous  or  ethereal 
fluids,  containing  exact  percentages  of  hydrogen  peroxide.  The 
solutions  are  prepared  in  two  strengths,  aqueous  3  per  cent, 
solution,  and  ethereal  25  per  cent,  solution. 

Properties  and  Actions. — Pyrozone  3  per  cent,  solution  is 
a  rapidly  acting,  harmless  antiseptic,  which  can  be  employed 
externally  or  internally  without  danger  of  toxic  effects.  It 
may  be  used  in  all  cases  where  carbolic  acid  or  other  disinfect- 
ant is  indicated.  The  25  per  cent,  solution  is  a  bleaching  agent, 
and  when  applied  to  diseased  parts  acts  as  a  powerful  caustic, 
bringing  about  resolution  in  a  short  time. 

Therapeutic  Uses. — The  3  per  cent,  solution  is  used  in  cer- 
tain forms  of  indigestion  or  dyspepsia,  ulcers  of  the  stomach, 
and  gastritis;  25  per  cent,  solution  is  applied  to  ulcers,  syphil- 
itic patches,  pus-generating  surfaces,  and  for  chronic  eczema. 

Dental  Uses. — Pyrozone  is  used  in  the  3  per  cent,  solution 
as  a  mouth-wash;  it  is  non-poisonous,  and  in  cases  where  the 
micro-organisms  of  the  mouth  threaten  septic  invasion  of  the 
stomach,  it  forms  a  perfect  gargle  or  spray.  It  completely  de- 
stroys pus  and  mucous  secretions,  and  renders  the  mouth 
aseptic.  The  25  per  cent,  solution  is,  as  has  been  indicated, 
employed  principally  as  a  bleaching  agent,  and  is  proving  a 
most  valuable  drug  for  that  purpose. 


antizymotics.  135 

Peroxide  of  Sodium. 

Derivation. — Sodium  peroxide  is  obtained  by  adding  hydro- 
gen peroxide  to  an  excess  of  caustic  soda,  20  per  cent,  solution, 
which  is  then  poured  into  alcohol. 

Properties  and  Actions. — Sodium  peroxide  is  the  chemical 
analogue  of  hydrogen  peroxide,  and  is  dispensed  as  a  yellowish 
white  powder,  which  is  soluble  in  water,  which  action  produces 
an  increase  in  temperature  and  evolves  a  certain  arflount  of 
oxygen.  It  is  a  strong  caustic  alkaline,  which  properties  it  re- 
tains after  the  loss  of  part  of  its  oxygen,  becoming  Na20,  which 
in  combination  with  water,  is  ordinary  caustic  soda. 

Dental  Uses. — It  is  used  in  dental  practice  as  a  bleaching 
and  sterilizing  agent.  It  is  claimed  that  sodium  peroxide  re- 
moves more  completely  than  any  other  drug,  the  dental  tubular 
contents;  and  it  is  further  claimed  that  the  normal  translucency 
of  the  tooth  is  more  fully  restored. 

Permanganate  of  Potassium,  KgMn^Og. 

Derivation. — Permanganate  of  potassium  is  prepared  by 
fusing  the  black  oxide  of  manganese  with  chlorate  of  potassium 
and  caustic  potassa. 

Properties. — It  is  in  the  form  of  dark  purple  crystals;  it  is 
very  soluble  in  water,  forming  a  beautiful  lilac-colored  solution ; 
inodorless,  and  has  a  sweetish,  astringent  taste. 

Actions. — Permanganate  of  potassium  taken  internally  is 
a  stimulant,  and  is  given  with  benefit  in  dyspepsia;  is  a  mild 
escharotic,  and  a  powerful  disinfectant  and  deodorizer.  The 
solution  is  decomposed  by  organic  matters,  sulphides  and  sul- 
phites, yielding  up  its  oxygen  readily  (on  which  property  its  use 
depends),  and  is  coilverted  into  a  colorless  solution.  . 

The  most  important  uses  for  this  agent  are  external,  where 
it  is  employed  as  a  deodorizer  and  disinfectant  in  abscesses, 
ulcers,  cancers,  caries  of  the  bone,  etc.,  in  the  form  of  a  lotion 
and  spray,  while  the  powder  may  be  sprinkled  on  gangrenous 


136  DENTAL  PATHOLOGY  AND  DENTAL  MEDICINE. 

surfaces,  acting  as  a  local  stimiilaiit  as  well  as  a  deodorizer. 

Dose,  for  internal  use,  gr.  ^-j.  For  external  use,  i^  to 
water,  fSv-x. 

Dental  Uses. — It  is  employed  in  dental  practice  in  the  treat- 
ment of  foul  abscess,  in  diseases  of  the  antrum,  necrisis  of  the 
maxillary  bones,  ulcers  of  the  mouth  attended  with  fetid  dis- 
charges, offensive  breath,  etc. 

Iodoform^  CHI3. 

Derivation. — Iodoform  is  a  preparation  of  iodine.  It  is 
"obtained  by  the  action  of  chlorinated  lime  upon  an  alcoholic 
solution  of  iodide  of  potassium,  heated  at  104°  F.,  the  product 
being  iodoform  and  iodate  of  lime,  the  iodoform  being  separated 
by  boiling  alcohol." 

Properties. — Iodoform  is  in  the  form  of  small  yellow  crys- 
tals, which  are  soft  to  the  touch,  of  a  sweetish  taste;  is  volatile, 
and  has  a  very  unpleasant  odor  (which  may  be  covered  with  oil 
of  rose,  etc.)  ;  is  insoluble  in  water,  but  is  soluble  in  alcohol, 
ether,  chloroform,  and  the  essential  oils. 

Actions. — Iodoform  is  an  efficient  antiseptic,  inhibiting  and 
destroying  the  microbes  of  putrefaction  and  suppuration;  it  has 
also  slight  local  anesthetic  properties. 

Internally  in  small  doses  it  is  a  tonic,  alterative,  anodyne, 
and  antiseptic. 

In  large  doses  it  causes  a  form  of  intoxication,  followed  by 
convulsions,  collapse,  and  death. 

Dose,  gr.  j-v,  in  pill  form. 
.  Dental  Uses. — In  dental  practice  iodoform  is  a  valuable 
agent;  it  is  an  excellent  antiseptic  for  the  treatment  of  alveolar 
abscesses,  putrescent  pulps,  especially  when  combined  with  oil 
of  eucalyptus.  Prof  Peirce  recommends  iodoform  ground  with 
equal  parts  of  oil  of  cloves  and  oil  of  eucalyptus,  a  portion  of 
which  may  be  introduced  to  the  inflamed  part  on  the  point  of  a 
small  broach. 


ANTIZV3L0T1CS.  ±0  i 

Iodoform  is  also  serviceable  as  a  packing  for  the  pockets  of 
pyorrhoea  alveolaris,  and  as  a  dressing  or  packing  for  wounds, 
where  it  may  be  used  in  the  powdered  form  or  in  the  form  of 
a  gauze  wliich  is  prepared  for  the  purpose. 

Aristol. 

Derivations. — Aristol  is  a  preparation  of  iodine,  and  has 
gained  a  position  in  recent  therapeutics  as  a  perfect  substitute 
for  iodoform.  It  is  a  thymol  iodide,  and  is  ''produced  by 
treating  an  aqueous  solution  of  iodine  in  iodide  of  potassium 
with  an  aqueous  solution  of  thymol  in  the  presence  of  caustic 
potash." 

Properties. — Aristol  is  in  the  form  of  a  reddish  brown  pow- 
der; is  volatile,  and  has  a  slight  aromatic  odor,  though  when 
compared  with  iodoform  we  may  say  it  is  practically  inodorous. 
The  quantity  of  iodine  contained  in  it  is  from  45  to  50  per 
cent. 

Aristol  is  insoluble  in  water  and  glycerine,  slightly  soluble 
in  alcohol,  but  is  readily  soluble  in  ether,  chloroform,  collodion, 
and  the  fixed  and  ethereal  oils. 

Actions. — Aristol  is  an  efficient  antiseptic;  it  is  particularly 
applicable  as  a  dressing  for  wounds,  ulcerations,  and  abrasions 
of  the  skin  and  mucous  membrane. 

It  may  be  dusted  over  the  wound,  or  applied  in  the  form  of 
aristol  ointments  (compounds  of  vaseline  or  cold  cream)  or  in 
combination  with  collodion.  All  of  these  are  excellent  and  easy 
of  application.  Its  efficiency  as  an  antiseptic  and  alterative  is 
largely  due  to  the  fact  that  it  slowly  gives  off  its  iodine,  and  it 
is  also  due  to  this  fact  that  it  does  so  decompose,  when  exposed 
to  the  light  or  undue  heat,  that  it  should  be  kept  in  a  colored 
bottle  or  a  closed  box  and  in  not  too  warm  a  place.  If  this  is 
not  done,  the  loss  of  iodine  will  be  readily  noticed  by  its  grad- 
ually becoming  paler  in  color. 

Dental  Uses. — Aristol  is  a  welcome  addition  to  our  cata- 
logue of  therapeutic  agents.     I  have  found  it  an  excellent  agent 

10 


138  DENTAL  PATHOLOGY  AND  DENTAL   MEDICINE. 

for  treating  root-canals  from  which  putrescent  pulps  have  been 
removed  and  for  alveolar  abscesses.  It  can  also  be  used  advan- 
tageously in  combination  with  root-filling  materials;  it  may  be 
used  by  mixing  the  powder  with  chloro-percha,  or,  where  gutta- 
percha cones  are  to  be  used,  the  cone  may  be  dipped  in  a  solu- 
tion of  aristol  and  chloroform  and  immediately  carried  to 
position.  Dr.  Kirk  says  of  it  in  this  connection:  "I  have  made 
use  of  aristol  in  connection  with  root-filling  materials  by  an- 
other method.  A  strong  solution  of  aristol  is  made  in  the  oil 
known  to  house-painters  as  'Japan  dryer,'  sufiicient  of  the  drug 
being  added  to  make  the  liquid  somewhat  thinner  than  glycer- 
ine; into  this  is  worked  with  a  spatula  freshly  calcined  oxide  of 
zinc  until  the  mass  is  like  putty,  in  which  condition  it  is  to  be 
worked  into  the  root-canals.  The  mass  becomes  quite  hard,  and 
seems  to  fulfill  admirably  the  requirements  of  a  root-filling." 

Formalin.  • 

Derivation. — The  name  formalin  has  been  given  to  a  40 
per  cent,  solution  of  chemically  pure  formaldehyde  in  water. 
Formaldehyde  (CH2O),  as  is  well  known,  is  a  gaseous  body 
which  is  prepared  by  subjecting  methyl-alcohol  to  oxidation. 
It  is  readily  absorbed  by  water;  for  this  reason  it  is  put  on 
the  market  in  the  form  of  an  aqueous  solution  termed  "forma- 
lin." It  mixes  with  water  in  all  proportions,  making  it  easy, 
therefore,  to  prepare  any  dilution  required. 

Properties  and  Actions. — Formalin  can  be  used  either  in 
a  gaseous  or  liquid  form ;  it  is  non-poisonous,  of  a  peculiar, 
penetrating  odor.  When  brought  into  contact  with  the  animal 
skin,  undiluted  formalin  exerts  a  kind  of  tanning  effect,  mak- 
ing the  skin  impermeable  and  finally  brings  about  necrosis.  The 
tissue  is  destroyed  with  suppuration  or  formation  of  a  wound. 
Therapeutic  Uses. — Formalin  is  an  ideal  germicide,  disin- 
fectant, deodorant,  and  antizymotic,  possessing  the  same  germ- 
icidal power  as  corrosive  sublimate,  without  its  toxicity.     It  is 


ANTIZYMOTICS.  139 

used  in  aseptic  and  antiseptic  surgery,  for  inhalations,  in  oph- 
thalmic practice,  in  bacteriology,  as  a  hardening  and  preserving 
medium,  and  in  the  recognization  of  the  typhoid  bacillus. 

Dental  Uses. — It  may  be  used  in  dentistry  for  destroying 
the  nerves  of  teeth,  and  as  an  antiseptic  agent. 

Gaultheria. 

Derivation. — Gaultheria  is  obtained  from  the  leaves  of  the 
gaultherise  procumbens  (Ericaceae),  a  small  plant  common  to 
North  American  woods.  These  leaves  contain  tannic  acid, 
urson,  arbutin,  ericolin,  a  volatile  oil,  etc. 

Properties  and  Actions. — Gaultheria  has  an  aromatic,  bit- 
ter, and  astringent  taste.  The  volatile  oil  is  composed  princi- 
pally of  methyl  salicylate  and  gaultherilene,  which  produce 
pure  salycilic  acid. 

Therapeutic  Uses. — The  oil  of  gaultheria  is  antipyretic  and 
antiseptic,  and  is  used  in  wounds,  and  administered  internally 
for  auricular  rheumatism.  The  spirit  of  gaultheria  is  used  as 
a  flavoring  extract. 

Dental  Uses. — Gaultheria,  being  one  of  the  essential  oils, 
is  useful  to  the  dentist  for  its  antiseptic  properties,  either  alone 
or  combined  with  other  medicines  for  the  treatment  of  alveolar 
abscess  and  putrid  root  canals;  it  is  also  an  ingredient  of  local 
anesthetic  mixtures. 

Creasote. 

Derivation. — Creasote  is  one  of  the  products  of  the  distilla- 
tion of  wood-tar,  and  consists  principally  of  such  phenols  as 
phloral,  creasol,  methyl-creasol,  and  guaiacol.  It  can  also  be 
obtained  from  crude  pyroligneous  acid.  That  made  from  beech- 
wood,  however,  is  the  better  form  for  medicinal  use. 

Properties  and  Actions. — Creasote  is  a  colorless,  oily  fluid, 
with  an  odor  somewhat  resembling  carbolic  acid,  and  has  a 
burning  taste.     It  is  a  stimulant,  antiseptic,  styptic,  sedative. 


140  DENTAL   PATHOLOGY  AND  DENTAL   MEDICINE. 

and  rubefacient.  In  large  closes  it  is  a  narcotic  poison,  causing 
death  by  coagulating  the  albumen  of  the  blood,  preventing  its 
circulation  through  the  arteries.  It  is  used  in  small  doses,  gen- 
erally, for  its  astringent  qualities. 

Therapeutic  Uses. — Internally,  creasote  is  administered  for 
pulmonary  consumption,  chronic  bronchitis,  vomiting  and  gas- 
tric troubles,  diarrhoea,  diabetes,  etc.  Externally,  applied  to 
hemorrhages  from  wounds,  etc.,  diseases  of  the  skin,  eruptions, 
ulcers,  etc. 

Dental  Uses. — Creasote  has  for  many  years  been  employed 
in  dental  practice  for  relieving  odontalgia,  as  an  obtundant,  for 
alveolar  abscess,  ulcers  of  the  mouth,  etc.  Its  antiseptic  powers 
render  it  valuable  for  offensive  purulent  discharges;  and  its 
styptic  properties  are  sometimes  taken  advantage  of  in  the 
treatment  of  hemorrhage  after  extraction  of  teeth. 

Naphtiiol. 

Derivation. — Naphthol  is  derived  from  naphthalene  (C^qH^) 
which  is  a  coal-tar  product  and  in  the  form  of  white  crystals, 
having  a  strong,  unpleasant  odor;  soluble  in  alcohol,  but  not  in 
water.     This  alcoholic  solution  is  known  as  naphthol. 

Properties  and  Action. — There  are  two  forms  of  .naphthol, 
a-naphthol  and  /S -naphthol;  the  latter,  owing  to  its  less  irri- 
tating effects,  is  generally  employed  medicinally.  It  is  a  light- 
brown  crystal,  soluble  in  hot  water. 

Therapeutic  Uses. — Owing  to  its  antiseptic  properties  it  is 
used  in  parasitic  diseases  of  the  skin ;  it  is  given  internally, 
and  applied  externally  as  an  ointment. 

Dental  Uses. — ITydronaphthol,  supposed  to  be  a  form  of 
,'3-naphthol,  is  most  generally  used  in  detal  practice  for  treating 
canals  and  pulpless  teeth,  pericemental  inflammation  of  septic 
jrigin,  especially  in  early  stages  before  pus  has  formed.  Pro- 
fessor James  Truman  recommends  a  solution  of  1 :  1000  of  water 
for  injection  into  pulp  canals.     It  is  also  recommended  as  an 


AXTJZYMOTICS.  141 

ingredient   for   a   mouth- wash   for   diseased   gums   and   mucous 
membrane. 

Campho-phenique,  C^Hj^O. 

Derivation. — Campho-phenique  is  obtained  from  the  chemi- 
cal union  of  carbolic  acid  and  camjihor.  It  is  prepared  as  fol- 
lows:  Nine  parts  of  carbolic  acid  to  one  part  of  alcohol  are 
mixed  with  twenty-five  parts  camphor.  The  clear  oily  solution 
is  the  result. 

Properties  and  Actions. — Campho-phenique  is  a  limpid, 
volatile  fluid,  having  an  aromatic  taste  and  the  odor  of  camphor. 
It  is  an  antiseptic,  a  mild  local  anesthetic,  and  germicide;  is 
non-irritant,  non-poisonous;  insoluble  in  water  or  glycerine, 
but  will  mix  in  all  proportions  with  alcohol,  ether  or  chloroform. 

Dental  Uses. — As  a  dressing  in  the  treatment  of  putrescent 
pulp-canals  it  has  given  quite  satisfactory  results.  It  has  been 
employed  hypodermically  as  a  local  anesthetic,  causing  no  con- 
stitutional disturbance.  It  is  also  recommended  for  the  relief 
of  pain  following  the  extraction  of  teeth,  in  which  case  it  is 
introduced  into  the  sockets  upon  pledgets  of  cotton. 

Cinnamon  (Cassia  Bark). 

Source. — The  commercial  cinnamon  is  the  prepared  bark  of 
a  tree  of  the  natural  order  Lauraceae.  The  best  varieties  of 
this  bark  are  obtained  from  Ceylon.  It  contains  a  volatile  oil, 
an  acid  peculiar  to  itself — cinnamic  acid — a  trace  of  tannic 
acid,  mucilage,  etc. 

Properties  and  Actions. — Cinnamon  is  placed  upon  the 
market  in  the  form  of  long,  thin,  cylindrical  pieces,  having  a 
yellow-brown  color,  a  fragrant  odor,  and  a  sweetish,  aromatic, 
and  mildly-astringent  taste.  It  is  more  powerful  as  a  local 
than  as  a  general  stimulant.  Its  medicinal  virtues,  however, 
reside  in  a  volatile  oil,  oleum  cinnamomi,  or  oil  of  cinnamon. 


142  DENTAL  PATHOLOGY  AND  DENTAL  MEDICINE. 

Therapeutics. — Cinnamon  is  sometimes  employed  to  allay 
nausea  and  vomiting,  and  in  combination  with  chalk  and  with 
other  astringents  it  is  used  for  the  treatment  of  diarrhoea.  The 
oil  of  cinnamon  is  often  employed  to  conceal  the  taste  of  other 
medicines,  and  is  a  strong  local  stimulant. 

Oil  of  Cassia. — Oil  of  cassia  is  prepared  from  the  bud  of 
the  same  order  of  tree,  and  the  oil  of  cinnamon  from  the  bark. 
The  oil  of  cassia  is  preferred  by  many  as  an  antiseptic  for  local 
treatment. 

Dental  Uses. — Oil  of  cinnamon  and  oil  of  cassia  are  em- 
ployed by  many  as  antiseptics  in  dental  practice.  In  the  treat- 
ment of  putrescent  root-canals  the  writer  has  secured  very  sat- 
isfactory results  from  both  these  drugs.  Applied  to  exposed 
and  inflamed  dental  pulps,  they  will  give  temporary  relief,  and 
have  been  recommended  for  the  treatment  of  pyorrhoea  alveo- 
laris,  combined  with  iodoform.  Dr.  Black's  "1,  2,  3  mixture" 
is  composed  of  oil  of  cinnamon,  1  part;  carbolic  acid  (crystals), 
2  parts;  oil  of  gaultheria,  3  parts.  This  is  employed  in  the 
local  treatment  of  pyorrhoea  alveolaris,  and  for  alveolar  ab- 
scesses, etc. 

Electrozone. 

Derivation. — Electrozone  is  the  product  of  sea- water  speci- 
ally treated  by  electrolysis.  It  has  been  so  named  from  the  fact 
that  it  is  manufactured  with  the  aid  of  the  electric  current, 
and  the  oxidizing  agent  being  ozone.  The  result  of  electrolysis 
thus  performed  is  the  formation  of  new  compounds,  consisting 
of  the  hypochlorites,  hypobromites,  etc.,  and,  it  is  claimed,  the 
substitution  of  free  oxygen  and  peroxide  of  hydrogen  for  the 
air  between  the  molecules  of  water. 

Properties  and  Actions. — It  is  a  clear,  colorless  liquid,  hav- 
ing an  unpleasant,  salty  taste,  and  an  odor  resembling  chlorine. 
It  is  a  non-poisonous  and  efficient  antiseptic,  germicide,  and 
disinfectant. 


CATHARTICS.  143 

Therapeutic  Uses. — It  is  much  used  for  diphtheria,  catarrh^ 
and  fevers,  and  is  applied  to  burns,  scalds,  and  wounds  of  any 
nature. 

Dental  Uses. — It  is  valuable  to  the  dentist  for  its  antiseptic 
and  germicidal  qualities,  and  is  very  efficacious  in  the  treat- 
ment of  acute  pulpitis,  giving  almost  instant  relief.  The 
writer  has  also  found  it  very  valuable  in  the  treatment  of  root- 
canals,  as  a  mouth- wash,  and  wherever  a  harmless  germicide 
and  deodorizer  is  desirable. 

CATHAETICS. 

Cathartics,  or  purgatives,  are  agents  which  hasten  the  intes- 
tinal evacuations;  they  comprise  such  substances  as  magnesia 
preparations  (Epsom  salts),  senna,  rlnibarb,  fruits  of  various 
kinds,  etc. 

Magnesia^  MgO. 

Derivation. — Magnesia,  or  magnesium  oxide,  is  obtained  by 
subjecting  magnesium  to  a  red  heat  in  the  open  air,  when  it 
will  burn  with  a  bright  light  and  produce  MgO. 

Properties. — Magnesia  is  a  very  light,  white  powder,  odor- 
less, has  an  earthy  taste,  is  freely  soluble  in  water — more  so  in 
cold  water — and  neutralizes  acids. 

Actions. — Magnesia  is  an  efficient  aperient  (mild  purga- 
tive), is  antacid — whence  an  excellent  remedy  for  great  acidity, 
of  the  stomach — and  is  the  antidote  for  poisoning  by  mineral 
acids.  When  it  is  desirable  to  administer  magnesia  in  large 
doses  and  for  a  considerable  length  of  time,  it  may  be  given 
in  connection  with  lemonade,  which  will  render  it  more  soluble, 
avoiding  its  accumulation  in  the  bowels. 

Chief  Preparations: — 

Sulphate  of  Magnesia,  "Epsom  salts,"  "salts."  Dose,  3j-§j, 
in  water,  a  popular  purgative. 


144  DENTAL   PATHOLOGY  AND  DENTAL   MEDICINE. 

Liq.  Citrate  of  Magnesia  (magnesium  carbonate),  citric 
acid,  potassium  bicarbonate,  and  water.     Dose,  5iv-vj. 

Dose  of  Magnesia  as  an  aperient,  gr.  x-3j.  As  an  antacid, 
gr.  20(9j). 

Dental  Uses. — The  form  of  magnesia  usually  employed  in 
dental  practice  is  known  as  magnesium  hydrate,  or  milJc  of 
magnesia,  and  consists  of  precipitated  magnesium  hydrate  held 
in  suspension  in  water,  and  is  employed  for  counteracting  the 
injurious  action  of  acid  secretions,  especially  in  cases  of  erosion. 
It  is  applied  in  the  same  way  that  lime-water  or  precipitated 
chalk  is  used  for  the  purpose  of  bringing  about  an  alkaline 
condition  of  the  oral  fluids,  by  neutralizing  the  excess  of  acids 
present.  A  teaspoonful  of  the  preparation  taken  into  the 
mouth  and  allowed  to  float  about  the  teeth  coats  them 
with  a  slight  alkaline  film,  which  protects  the  tooth  surface 
from  the  acid  action  for  several  hours. 

MISCELLANEOUS  DEUGS. 

GLYCERm. 

Derivation. — Glycerin  is  a  production  of  the  saponification 
of  fijied  oils  and  fats;  it  also  contains  a  small  percentage  of 
water. 

Properties  and  Actions. — It  is  a  colorless,  syrupy  liquid, 
having  a  sweet  taste  but  no  odor;  soluble  in  water  or  alcohol. 
It  is  a  solvent,  preservative,  emollient,   and  nutrient. 

Therapeutic  Uses. — It  is  used  to  dissolve  iodine,  iodide  of 
potassium,  borax,  tannic  acid,  creasote,  carbolic  acid,  etc.  It  is 
much  used  in  poultices  and  for  roughness  of  the  skin,  as  one  of 
the  ingredients  for  dressings  for  wounds  and  ulcers,  erysipelas, 
and  small-pox  (to  prevent  pitting).  Glycerin  is  used  in  cases 
of  earache  and  deafness.  It  should  be  mixed  with  a  little  water 
before  applying  to  abraded  or  cut  surfaces  to  prevent  smarting. 

Dental  Uses. — Glycerin  is  much  used  in  dotal  practice  as 
a  solvent  and  emollient.    It  is  used  in  the  treatment  of  diseases 


M  ISCMLI.AM^ors    DKl'CiS.  145 

of  the  mucous  membrane  of  the  mouth,  such  as  ulcers,  stoma- 
titis, alveolar  abscess,  etc.  Combined  with  lime-water,  rose- 
water,  gum  tragacanth,  etc.,  it  forms  ointments  and  emollients. 
Combined  with  atropine,  acetate  of  lead,  morphine,  etc.,  it  is 
used  as  an  anodyne  and  emollient. 

Collodion. 

Derivations. — Collodion  is  a  solution  of  pyroxylin,  stronger 
ether,  and  alcohol,  in  the  proportion  of  4,  70,  and  26  respec- 
tively. Pyroxylin,  or  common  gun-cotton,  is  a  mixture  of 
nitric  and  sulphuric  acids  added  to  cotton  freed  from  im- 
purities. 

Properties  and  Actions. — Collodion  is  a  colorless,  inflam- 
mable liquid,  of  the  consistency  of  syrup,  with  an  ethereal  odor. 
It  is  used  to  protect  abraded  or  cut  surfaces  from  the  air,  by 
means  of  the  film  which  it  forms.  Owing  to  its  astringent  ten- 
dencies it  draws  together  and  holds  in  apposition  divided  parts. 

Therapeutic  Uses. — It  is  applied  to  ulcers,  abraded  surfaces, 
fissures,  and  is  also  used  in  skin  diseases  and  erysipelas. 

Dental  Uses. — Combined  with  carbolic  acid  it  is  applied  for 
odontalgia.  With  iron,  etc.,  it  forms  a  styptic  preparation. 
When  a  number  of  layers  are  applied,  it  will  sometimes  prevent 
an  alveolar  abscess  from  discharging  on  the  face,  causing  it  to 
open  in  the  mouth.  It  is  useful  in  the  dental  laboratory  for 
coating  plaster  models,  protecting  the  surface.  Should  it  be- 
come too  thick,  dilute  with  a  solution  of  ether  and  alcohol, 
3  to  1. 

Sandaraoh. 

Derivation. — Sandarach  is  derived  from  an  evergreen  tree 
common  to  Northern  Africa. 

Properties  and  Actions. — Sandarach  gum  is  in  the  form 
of  small,  irregular  drops,  of  a  light  yellow  color,  occasionally 
brown;   brittle,  and  slightly  transparent.     It  has  an  agreeable 


146  DENTAL  PATHOLOGY  AND  DENTAL   MEDICINE. 

odor  and  a  resinous,  acrid  taste.  It  is  inflammable,  and  when 
melted  by  heat  throws  out  a  strong  balsam  odor.  It  dissolves 
readily  in  alcohol  or  ether. 

Dental  Uses. — The  alcoholic  solution  of  sandarach  is  much 
used  in  dental  practice  as  a  varnish  for  coating  plastic  fillings, 
etc.;  and  applied  on  cotton  as  a  temporary  stopping,  and  for  a 
coating  for  cotton  used  for  separating  purposes. 

ANTACIDS. 

Bicarbonate  of  Soda,  2NaIIC03. 

Sodium  bicarbonate  is  a  white  powder,  having  a  mildly  aUva- 
line,  cooling  taste.  It  is  soluble  in  water,  insoluble  in  alcohol. 
Alkaline  in  reaction. 

Dental  Uses. — Sodium  bicarbonate  is  used  in  dental  prac- 
tice to  counteract  the  actions  of  acids,  and  is  sometimes  em- 
ployed as  an  antacid  ingredient  of  dentifrices,  etc. 

Borax,  Na22B202. 

Borax,  or  sodium  borate,  is  a  white  powder  having  an  alka- 
line taste  and  reaction.  It  is  both  alkaline  and  antiseptic  and 
may  be  used  in  a  saturated  solution  where  these  qualities  are 
desired. 

Dental  Uses. — It  is  sometimes  employed  in  mouth-washes, 
particularly  in  the  treatment  of  stomatitis  or  thrush.  The 
latter  trouble  occurring  usually  in  the  mouths  of  infants,  a 
saturated  solution  of  glycerin  has  been  suggested  for  the  treat- 
ment of  same.  Borax  is  also  useful  in  blow-pipe  analysis,  as  a 
flux  in  soldering  metals,  in  solution  for  hardening  plaster 
casts,  etc. 

Lime  Water. 
A  saturated  solution  of  calcium  hydrate  in  water.     It  is  a 
colorless,   nearly   odorless   liquid,    alkaline   in   reaction.     Lime 


ANTACIDS.  147 

water  is  readily  prepared  by  treating  freshly  slaked  lime  with 
distilled  water. 

Dental  Uses. — ^Lime  water  may  be  used  freely  as  an  antacid 
mouth-wash  and  gargle.  It  may  also  be  used  to  correct  acidity 
of  the  stomach,  and  is  frequently  added  to  the  food  of  infants 
for  this  purpose. 

Magnesia  (see  Cathartics). 

Prepared  Chalk^  CaCOg. 

This  substance  is  a  form  of  calcium  carbonate.  It  is  a 
white  powder,  sometimes  moulded  into  small  blocks  or  cones, 
almost  tasteless,  very  slightly  soluble  in  water  and  insoluble  in 
alcohol;  it  is  antacid,  absorbent  and  astringent.  It  is  prepared 
by  freeing  chalk  from  impurities  and  gritty  substances  by 
elutriation  (e-lu-tre-a'shun) . 

Dental  Uses. — The  insolubility  and  antacid  property  of 
prepared  chalk  gives  it  special  value  as  a  basis  for  tooth  powders 
and  as  a  packing  between  teeth  over  night  where  there  is  a 
strong  tendency  to  acidity.  It  is  employed  by  some  dentists  to 
Telieve  sensative  dentine  in  cavities  of  decay  or  erosion.  In 
such  cases  it  is  employed  for  several  days  before  operating.  It 
is  used  in  the  laboratory  for  polishing  purposes. 


APPENDIX. 


EMERGENCIES. 

Preliminary  Remarks. 

Nothing,  of  course,  can  take  the  place  of  the  advice  and 
service  of  an  experienced  physician  in  time  of  emergencies; 
but  the  physician  is  not  always  at  hand,  and  accidents  of 
various  kinds  may  occur  in  the  dental  office,  or  patients  in 
distress  present  themselves  to  the  dental  practitioner  for  im- 
mediate relief;  or  some  one  may  be  burned,  cut,  poisoned,  or 
suffocated,  where,  if  we  possess  presence  of  mind  and  sufficint 
knowledge,  it  may  be  our  privilege  to  save  an  endangered  life. 
It  is,  therefore,  expedient  that  the  dental  student  should  have  a 
more  thorough  knowledge  of  what  to  do  in  case  of  such  emer- 
gencies; it  is  for  that  purpose  that  this  chapter  of  practical 
suggestions  is  prepared. 

Apoplexy  is  the  rupturing  of  a  blood-vessel  in  the  brain. 
The  symptoms  are  stupor,  heavy  snoring  breathing,  slow  pulse, 
flushed  face,  followed  by  paralysis  usually  of  one  side,  this 
being  marked  by  the  drawing  up  of  one  side  of  the  face. 

Treatment. — Loosen  clothing  about  the  neck,  make  cold  ap- 
plications to  the  head,  and  keep  the  patient  in  a  sitting  posture 
until  the  physician  arrives. 

Burns  or  Scalds. — Not  infrequently  does  some  one's  cloth- 
ing take  fire,  usually  that  of  women,  on  account  of  the  charac- 
ter of  their  clothing.  The  first  thing  to  do  in  time  of  such  an 
accident  is  to  have  the  patient  lie  down,  but  if  she  loses  her 
presence  of  mind  and  will  not  obey  instructions,  she  must  be 
quickly  placed  upon  the  floor  or  ground  and  then  covered  or 
enveloped  at  once  with  the  first  article  you  seize  that  will  ex- 

148 


APPEADJX.  149 

elude  the  air  and  smother  the  flame — a  breadth  of  carpet,  rug, 
blaiilvet,  or  coat  will  serve  the  purpose. 

After  the  fire  is  extinguished,  or  after  an  extensive  scald,  if 
there  is  m.uch  of  a  burn  or  blister,  the  clothing-,  as  much  as 
need  be  removed,  should  be  carefidly  clipped  away,  so  as  not  to 
break  the  blisters  that  may  have  formed.  These  may  be  punc- 
tured at  one  edge  and  their  contents  discharged,  when  the  outer 
skin  will  fall  back  in  place.  Then  a  dressing  of  pure  sweet  oil 
or  castor  oil  should  be  carefully  applied  on  strips  of  soft  linen. 
When  the  skin  is  destroyed,  the  air  may  be  excluded  by  apply- 
ing at  once  any  of  the  following :  sweet  oil,  linseed  oil,  collodion, 
vaseline,  etc.  Dr.  Charles  Dulles,  in  his  manual  on  accidents 
and  emergencies,  says :  "In  case  of  a  person  severely  and  ex- 
tensively burned,  the  entire  body  may  be  immersed  in  a  bath, 
which  shall  be  kept,  as  long  as  necessary,  at  a  temperature  of 
100°.  Where  the  shock  of  a  burn  is  great  some  stimulant  should 
be  given,  and  laudanum,  in  twenty-droi:)  doses  to  an  adult,  and 
half  as  much  to  a  child,  to  allay  the  suffering." 

For  Slight  Burns  or  Scalds,  an  excellent  dressing  is  to 
quickly  sprinkle  the  parts  with  bicarbonate  of  soda  and  cover 
same  with  wet  cloth,  or  they  may  be  painted  with  white  lead, 
or  covered  with  the  white  of  an  egg  or  carron  oil  (equal  parts 
of  linseed  oil  and  lime  water) — in  fact,  anything  that  will  ex- 
clude the  air  and  prevent  friction,  and  will  not  prevent  after- 
examination,  may  be  used.  Aristol  ointment  (aristol  in  cold 
cream  or  vaseline)  is  also  being  used  with  good  results,  while 
for  small  burns  on  the  hand,  arm,  leg,  etc.,  immerse  instantly 
in  cold  water,  and  let  it  remain  for  some  length  of  time. 

Burns  with  Acids  or  Caustic  Alkalies,  such  as  soap  lye, 
should  be  deluged  with  water,  and  followed  by  an  application  of 
bicarbonate  of  soda  for  the  former  and  vinegar  for  the  latter, 
to  be  followed  by  an  application  of  oil. 

Catalepsy  in  appearance  somewhat  resembles  death.  The 
patient  becomes  unconscious,  the  muscles  rigid,   and  the  skin 


150  APPENDIX. 

pallid.  In  itself  it  is  by  no  means  dangerous,  and  it  affords  time 
enough  to  summon  a  doctor,  which  is  the  only  sensible  thing  to 
do  under  these  circumstances. 

Choking  is  usually  caused  by  the  lodgment  of  some  foreign 
substance  in  the  trachea  or  oesophagus.  When  the  body  is 
lodged  in  the  trachea,  there  is  great  irritation  and  coughing, 
though  it  does  not  materially  interfere  with  deglutition.  While, 
on  the  other  hand,  when  the  oesophagus  is  closed,  it  is  usually 
impossible  to  swallow,  and  there  is  little  or  no  coughing. 

Treatment. — Hold  the  head  low  and  slap  the  back  quite  forc- 
ibly. Blow  into  the  ear,  which  will  excite  a  reflex  action  that 
will  aid  the  patient  in  expelling  the  foreign  body.  The  re- 
moval of  pins,  needles,  splinters,  fish  bones,  etc.,  from  the 
throat  is  usually  an  extremely  delicate  operation.  They  should 
be  grasped  with  a  small  pair  of  forceps  or  tweezers,  or  a  blunt 
pair  of  scissors  may  be  used  for  the  same  purpose. 

Convulsions  are  usually  caused  by  some  irritation  of  the 
digestive  apparatus,  or  hy  some  interference  in  the  eruption  of 
the  teeth. 

Treatment. — When  the  physician's  coming  is  delayed,  the 
child  should  be  placed  in  a  hot  bath;  the  head  at  the  same  time 
should  be  kept  cool  by  cold  applications.  This  should  be  con- 
tinued for  about  ten  minutes,  when  the  child  should  be  wrapped 
in  warm  blankets  and  put  to  bed.  If  there  should  he  one  or 
more  teeth  endeavoring  to  erupt  at  this  time,  the  gums  should, 
he  freely  lanced. 

Dislocations  can  be  easily  detected.  There  is  always  de- 
formity, pain,  and  stiffness  of  the  joint  affected. 

Dislocation  of  the  lowerjaw,  with  treatment  for  same,  is 
fully  treated  upon  pages  62  and  63. 

Dislocation  of  the  fingers  can  easily  be  corrected  by  strong 
pulling  and  at  the  same  time  pressing  the  parts  into  place,  where 
they  should  be  retained  for  several  days  by  a  splint  and  bandage. 

Dislocations  of  other  joints  had  better  be  left  for  the  sur- 
geon's hands.     "The  risk  of  doing  injury  by  injudicious  efforts 


APPENDIX.  151 

to  set  a  joint  is  greater  than  that  of  waiting  until  a  surgeon 
can  be  summoned."  The  patient,  however,  should  be  placed  in 
the  most  comfortable  position  and  hot  fomentations  should 
be  applied. 

Drowning. — It  is  important  to  remember  that  the  body  as 
a  whole,  is  a  very  little  lighter  than  water;  therefore,  a  person 
who  is  in  danger  of  drowning  should  lie  flat  on  the  back  and 
keep  the  entire  body,  with  the  exception  of  the  mouth  and 
nose,  under  water.  The  arms  should  be  stretched  at  full  length 
above  the  head,  and  the  lungs  should  be  kept  filled  with  air  as 
much  of  the  time  as  possible.  This  would  very  materially  aid 
both  the  one  in  danger  and  the  rescuing  party. 

Resuscitation. — Avoid  delay.  Do  not  wait  to  carry  the 
patient  to  a  house  or  hospital,  but  treat  him  on  the  spot.  "Re- 
member that  the  patient  is  suffering  from  two  things,  want  of 
air,  or  oxygen,  and  loss  of  heat  from  the  body."  The  first  thing 
to  do,  then,  is  to  free  the  body  from  any  clothing  that  may  in- 
terfere with  respiration — that  is,  about  the  neck,  chest,  and 
waist.  If  natural  breathing  has  ceased,  artificial  respiration 
should  be  commenced  as  soon  as  possible.  First,  hastily  make 
a  roll  from  clothing,  blanlvets,  or  anything  that  may  be  at  hand, 
place  the  patient  over  this,  face  doivnward,  allowing  his  fore- 
head to  rest  upon  one  hand  to  keep  the  mouth  and  nose  clear 
of  the  ground.  Place  the  hands,  well  spread,  upon  the  patient's 
back,  over  the  stomach  and  base  of  thorax.  Then,  with  a  for- 
ward motion,  throw  all  the  weight  upon  them  that  the  age  and 
sex  of  the  patient  will  justify.  Repeat  this  three  or  four  times, 
which  will  cause  the  water  and  mucous  to  run  out  of  the  mouth, 
throat  and  trachea.  (See  Fig.  29.)  Wrap  a  handkerchief 
around  the  forefinger  and  pass  it  into  the  mouth  and  remove 
any  mucus  that  may  remain.  Turn  the  patient  on  his  back, 
grasp  the  tongue  and  draw  it  forward  and  down  onto  the  chin; 
lay  a  strip  of  the  handkerchief  or  other  material  across  the 
tongn.e  and  pass  the  ends  behind  the  neck  and  tie,  or  have  some 


152 


APPENDIX. 


APPENDIX.  153 

one  to  hold  the  tongrie  to  keep  it  from  falling  back  and  closing 
the  throat.     Then  begin  artificial  respiration. 

Howard's  Method. — The  patient  is  placed  upon  his  back, 
his  arms  extended  backward  and  outward,  where  they  should  be 
held  by  an  assistant.  A  roll  of  something  (clothing,  a  folded 
blanket,  coat,  or  stick  of  wood,  if  nothing  better  is  at  hand)  is 
then  placed  under  the  false  ribs  so  as  to  throw  them  prominently 
forward.  The  operator  should  then  kneel  astride  the  patient's 
abdomen,  placing  both  hands  so  that  the  fingers  will  press  into 
the  intercostal  spaces  on  each  side,  and  the  base  of  the  thumb 
rest  upon  the  anterior  margin  of  the  false  ribs.  The  operator 
should  then  place  his  elbows  firmly  against  his  sides,  and  throw 
himself  forward,  bringing  his  weight  to  bear  upon  the  patient's 
false  ribs,  forcing  them  inward  and  upward  toward  the  dia- 
phragm, then  suddenly  let  go  and  return  to  the  erect  position. 
Repeat  these  movements  ten  to  twelve  times  a  minute  until 
natural  breathing  begins,  which  may  gradually  take  the  place 
of  the  artificial.     Fig.  30  illustrates  this  method. 

Sylvester's  Method. — After  the  patient  has  been  placed 
upon  his  back,  with  folded  clothing  under  his  shoulders,  the 
operator  should  kneel  behind  his  head  and  go  through  the 
following  manipulations : — 

First,  to  induce  inspiration :  Grasp  both  arms  just  below  the 
elbows  and  swing  them  around  horizontally  until  they  nearly 
meet  above  the  head,  with  the  back  of  the  hands  or  elbows 
touching  the  ground;  hold  them  there  for  three  or  four  seconds. 
This  draws  the  ribs  up  so  as  to  expand  the  chest  and  allows  the 
air  to  enter  the  lungs.     (See  Fig.  31.) 

The  second  movement  is  to  induce  expiration.  Bend  the  arms 
at  the  elbows,  and  carry  them  down  so  that  they  rest  upon 
either  side  of  the  chest.  Bring  the  weight  of  your  body  upon 
them,  pressing  forcibly  and  steadily,  which  pressure,  if  con- 
tinued for  a  few  seconds,  will  force  the  air  out  of  the  lungs. 

11 


154 


APPENDIX. 


APPENDIX.  155 

(See  Fig.  32.)  These  movements  should  be  continued  alter- 
nately twelve  to  fifteen  times  a  minute. 

When  natural  hreathing  is  attempted,  it  may  be  stimulated 
by  applying  smelling  salts  or  anmaonia  to  the  nose,  or  by  slap- 
ping the  chest.  When  the  patient  is  able  to  swallow,  some 
stimulant  should  be  given  every  few  minutes  until  the  danger- 
point  is  passed — such  as  a  teaspoonful  of  whisky  or  brandy,  or 
double  the  quantity  of  hot  water.  After  the  patient  is  resus- 
citated he  should  be  wrapped  in  warm  blankets  and  carefully 
carried,  with  the  head  low,  to  a  warm  bed. 

Epileptic  Fits  are  characterized  by  sudden  loss  of  conscious- 
ness and  power  of  co-ordination  of  motion;  there  is  a  rigidity 
of  motion  which  is  followed  by  violent  convulsions  of  short 
duration,  usually  accompanied  by  more  or  less  foaming  at  the 
mouth.  There  is  also  a  peculiar  cry  that  accompanies  these 
attacks,  caused  by  laryngeal  spasms. 

Treatment. — There  should  be  no  struggling  with  the  patient, 
but  an  effort  should  be  made  to  regulate  the  movements  so 
that  the  patient  will  not  do  himself  any  harm.  A  folded  napkin 
or  towel  or  a  soft  piece  of  wood  should  be  placed  between  the 
teeth  to  prevent  biting  the  tongue.  As  soon  as  the  convulsions 
are  passed,  the  patient  should  be  allowed  to  rest  quietly  in  bed 
for  some  time.  Dr.  Dulles  says:  "It  would  be  a  good  plan  if 
every  one  who  is  subject  to  epileptic  attacks  had  his  or  her 
name  and  address  placed  inside  the  coat  or  in  some  place  where 
it  could  be  seen  at  once  when  the  clothing  is  loosened  to  give 
relief,  as  is  almost  invariably  done  when  such  attacks  occur. 
Epileptics  should  not,  except  where  it  is  absolutely  unavoidable, 
go  about  alone,  or  go  into  crowded  places.  They  have  no  right, 
on  their  own  account  and  for  the  sake  of  others,  to  incur  risks 
involved  in  such  conduct,  except  under  stress  of  necessity." 

Exhaustion,  Heat. — This  is  not  a  serious  illness.  It  is 
usually  caused  by  physical  overwork  in  hot  and  badly  ventilated 
rooms  or  in  the  heat  of  summer, — the  latter  is  apt  to  be  con- 
founded with  heat  or  sunstroke.    In  heat  exhaustion,  however, 


156 


APPENDIX. 


APPENDIX. 


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158  APPENDIX. 

there  is  a  cool,  moist  skin,  while  in  sunstroke  the  bodily  tem- 
perature is  raised  and  the  skin  is  quite  dry. 

Treatment  of  heat  stroke  is  very  simple.  The  patient  should 
have  complete  rest,  plenty  of  fresh  air,  and  a  mild  stimulant — 
hot  soup,  milk,  tea,  or  coffee,  or  a  small  dose  (one  or  two  tea- 
spoonfuls)  of  wine  or  brandy. 

Fainting  is  caused  by  the  cutting  off  of  the  supply  of  blood 
to  the  brain,  which  is  due  to  a  temporary  weakening  of  the 
heart's  action. 

Treatment. — If,  for  any  reason,  the  patient  does  not  fall  to 
the  floor  or  couch  so  as  to  bring  the  head  low,  the  body  should 
be  placed  in  such  a  position.  This  is  to  aid  the  heart  in  sending 
the  blood  to  the  brain,  and  if  the  head  is  placed  a  little  lower 
than  the  body,  the  force  if  gravity  will  aid  very  much  in  sending 
the  blood  where  it  is  needed.  At  the  same  time  the  clothing 
should  be  lossened  and  plenty  of  fresh  air  admitted.  Cold 
water  may  be  sprinkled  upon  the  face,  and  ammonia  or  smelling 
salts  applied  to  the  nose  tend  to  excite  the  nerves  of  sensation 
and  rouse  the  heart  to  renewed  activity. 

Fractures. — Fractured  bones  may  be  recognized  by  the  de- 
formity and  abnormal  mobility  of  the  parts  affected.  It  is 
also  usually  accompanied  by  crepitus, — a  clicking  or  grating 
sensation  at  the  point  of  fracture. 

The  treatment  of  fractures  should  not  be  attempted  by  any 
one  who  has  not  surgical  training,  and  as  there  is  no  great  haste 
necessary,  an  effort  should  be  made  to  simply  place  the  patient 
in  as  comfortable  a  position  as  possible  until  the  physician  ar- 
rives. The  following  notes  and  illustration  (Fig.  33)  are  taken, 
with  permission  of  the  author,  from  Dr.  G.  R.  Butler's  "Emer- 
gency Notes" : — 

"If  patient  must  he  moved^  or  travel  some  distance,  apply 
temporary  splints  or  dressings  to  prevent  further  injury  from 
movement. 


APPENDIX. 


159 


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160  APPENDIX. 

"In  city  or  country  one  of  the  following  list  of  materials  may 
usually  be  found,  and,  by  the  aid  of  a  little  ingenuity,  utilized 
for  temporary  dressings  : — 

''^For  splints — Cigar  boxes,  pasteboard  (boxes,  book-covers), 
folded  newspapers,  shingles,  barrel-staves,  umbrellas,  walking- 
sticks,  rulers,  paper-cutters,  branches,  twigs,  straw,  fence-pal- 
ings, spoons,  tongs. 

"For  padding — Cotton,  flannel,  towels,  flax,  jute,  oakum,  hay, 
moss,  pieces  of  blanket,  coat-sleeves  or  stockings  stuffed  with 
grass,  hay,  straw,  or  leaves. 

"For  bandages — Handkerchiefs,  stockings,  garters,  suspend- 
ers, sheets,  blankets,  and  patient's  clothing  torn  into  strips. 

"The  temporary  treatment  of  the  following  special  fractures 
should  be  studied  and  personally  practised.  Some  of  these  im- 
provised splints  and  their  application  are  shown  in  Fig.  33. 

''Jaiv-hone — Four-tailed  bandage. 

"Collar-hone — Broad  bandage  around  chest  and  a^jm  of  in- 
jured side.     Broad  arm-sling. 

"Upper  arm-hone — Two  splints.     ^Narrow  arm-sling. 

"Foreariyi  and  wrist  hone — One  splint  reaching  to  base  of 
fingers.     Broad  arm-sling. 

"Rihs — Broad  bandage  around  chest,  applied  during  expira- 
tion— i.  e.,  chest  emptied  of  air. 

"Thigh-hone — Preferably  a  long  posterior  (back)  splint 
reaching  from  waist  to  heel.  If  this  can  not  be  secured,  simply 
tie  limbs  together. 

"Leg  and  anJde-hones — Internal  (inside)  splint,  or  tie  limbs 
together."    (See  Fig.  33  for  illustrations.) 

Freezing  of  the  ears,  nose,  hands,  or  feet  sometimes  takes 
place  in  such  a  deceptive  manner  that  much  damage  is  done 
before  it  is  recognized,  for  one  may  go  sometimes  with  a  part 
of  the  body  frozen  and  not  be  aware  of  it,  on  account  of  the 
absence  of  sensation  in  the  part,  which  is  due  to  the  freezing 
of  the  nerves. 


APPENDIX.  161 

Treatment. — Warmth  and  circulation  is  the  first  demand, 
and  this  should  be  restored  gradually  until  normal  (98°  Fahren- 
heit). This  is  best  accomplished  by  applying  snow  or  cold 
water  to  the  part,  to  which  gradually  add  warm  water;  gentle 
friction,  too,  is  found  beneficial.  The  after  efi^ects,  if  serious, 
should  have  similar  treatment  to  that  of  a  burn.  If  the  whole 
body  or  a  large  part  of  it  is  frozen,  after  tiie  normal  tempera- 
ture is  restored  the  patient  should  be  wrapped  in  warm  blankets 
and  given  some  internal  stimulant,  as  tea  or  coffee,  until  the 
physician  arrives. 

Hemorrhage. — There  is  no  accident  where  a  little  accurate 
knowledge  and  a  level  head  is  of  more  value  than  in  case  of 
hemorrhage,  whether  it  be  from  some  external  wound  or  from 
the  rupture  of  a  blood-vessel  internally.  Hemorrhage  may 
occur  from  three  sources,  the  arteries,  veins,  or  capillaries;  and 
its  source  can  usually  be  determined  by  the  color  and  manner 
in  which  the  blood  flows. 

Arterial  :  Hemorrhage  from  an  artery  is  very  dangerous,  and 
life  is  often  quickly  lost;  here  it  is  that  knowledge,  judgment, 
and  coolness  is  called  for.  The  blood  from  an  artery  is  bright 
red  and  flows'  in  jets,  each  jet  or  spurt  corresponding  to  the 
beating  of  the  heart. 

Venous  or  Capillary  Hemorrhage  is  marked  by  the  slow, 
steady  flow  of  blood,  it  being  darker  than  the  arterial  blood. 

Treatment. — The  first  thing  to  do  in  all  cases  of  hemorrhage 
is  to  elevate  the  bleeding  part,  whenever  possible,  above  the 
level  of  the  heart.  If  in  the  hand  or  arm,  raise  above  the  head. 
In  this  position  the  blood  has  to  travel  up  hill,  and  therefore 
reaches  the  wound  with  less  force,  which  means  slower  escape 
of  blood,  and  a  greater  likelihood  of  forming  a  clot  at  the  mouth 
of  the  wound.  Cold  water  or  ice  applied  to  the  parts  assists, 
especially  in  wounds  of  small  arteries,  by  contracting  the  ves- 
sels.    Styptics  should  be  applied  to  contract  the  bleeding  sur- 


162  APPENDIX. 

face*  and  to  aid  in  forming  a  clot.  Probably  the  best  remedies 
for  this  purpose  are  tannic  acid,  subsulphate  of  iron,  or  a  mix- 
ture of  vinegar  and  water,  about  one  part  of  the  former  to  four 
of  the  latter.  Pressure  on  the  artery  at  the  wounded  point  or 
above  the  wound  is  a  very  simple  expedient  and  will,  in  nearly 
all  cases,  prove  of  very  great  value  in  controlling  the  flow  of 
blood  until  more  permanent  means  can  be  employed.  Several 
methods  follow: 

Pressure  with  the  fingers  is  made  by  placing  one  finger  just 
above  and  one  below  the  wound,  and  crowding  the  edges  to- 
gether firmly. 

Pressure  by  compress  and  bandage  consists  of  making  a  com- 
press of  some  soft  material,  such  as  muslin,  linen,  cheese  cloth, 
etc.,  folded  into  suitable  shape  and  bound  securely  upon  the 
wound  with  a  bandage. 

Pressure  above  the  wound  may  be  made  by  the  finger,  or 
when  the  wound  is  in  a  limb  a  tourniquet  may  be  'employed, 
which  is  readily  made  by  tying  a  handkerchief  around  the 
limb  loosely,  with  secure  knots,  then  pass  a  pencil  or  knife 
through  the  handkerchief  and  twist  in  such  a  manner  as  to 
tighthen  it  sufficiently  to  stop  the  bleeding.  This  may  be  con- 
tinued until  a  surgeon  has  ligated  the  artery,  which,  if  neces- 
sary, should  be  as  soon  as  possible. 

Hemorrhage  from  the  Nose  is  not  infrequent  and  is  usually 
not  dangerous.  It  is  generally  due  to  the  rupture  of  some  of 
the  capillaries  of  the  lining  membrane  of  the  nose.  But  there 
are  times  when  the  bleeding  is  due  to  the  rupture  of  a  small 
artery,  possibly  from  ulceration,  when  it  is  so  profuse  as  to 
threaten  life.  In  some  cases,  which  are  very  rare,  medical  aid 
should  be  summoned  at  once. 

Treatment. — Have  the  patient  to  sit  upright,  and  to  hold  the 
hands  above  the  head,  at  least  the  one  on  the  bleeding  side. 


*See  page  126. 


APPENDIX.  163 

Take  a  towel  and  wring  out  of  ice  water  or  place  in  it  finely 
cracked  ice,  and  wrap  it  around  the  neck.  If  bleeding  con- 
tinues, have  patient  snuff  up  from  the  hand  or  inject  into  the 
nostrils,  with  a  small  syringe,  ice  water  and  alum,  a  teaspoon- 
ful  of  alum  to  a  half -glass  of  water.  Vinegar,  too,  used  in  the 
same  manner,  will  usually  stop  the  flow  of  blood.  But  if  these 
means  should  fail.  Dr.  Butler's  plan  will  be  found  very  good. 
He  says:  "Take  a  piece  of  cotton  wool  as  large  as  the  first  joint 
of  the  thumb,  tie  a  thread  around  its  middle,  soak  it  in  alum 
water,  or,  if  that  is  not  at  hand,  oil  it  with  sweet  oil  or  vaseline 
and  plug  the  nostril.  This  is  best  done  by  pushing  the  cotton 
with  a  screwing  or  twisting  motion  until  firmly  lodged.  The 
thread  serves  to  draw  it  out  when  required." 

Hemorrhage  from  the  Gums  can  usually  be  controlled  by 
syringing  the  mouth  or  sockets  (if  teeth  have  been  extracted) 
with  warm  water  to  remove  clots,  then  rinse  the  mouth  freely 
with  ice  water  and  alum.  If  this  should  fail,  some  good  styptic 
should  be  applied.  (See  page  69,  "Hemorrhage  after  Extrac- 
tion.") 

Hemorrhage  from  the  Stomach  may  be  caused  by  inflam- 
mation, cancers,  corrosive  poisons,  etc.,  or  may  occur  without 
any  apparent  cause.  It  is,  however,  not  a  very  frequent  occur- 
rence. The  blood  in  such  cases,  when  vomited,  is  usually  of  a 
dark  brown  color,  resembling  coffee  grounds,  unless  it  has  very 
recently  and  suddenly  escaped  into  the  stomach,  when  it  is  of 
a  bright  red  color.  Bleeding  from  the  stomach  should  not  be 
mistaken  for  bleeding  from  the  lungs.  It  is  therefore  impor- 
tant to  remember  these  facts :  that  blood  from  the  stomach  is 
usually  of  a  dark  brown  color  and  is  vomited  and  not  frothy, 
while  blood  from  the  lungs  is  of  a  'bright  red  color  and  is  frothy, 
also  that  it  is  coughed  up,  not  vomited. 

Treatment. — Hest  in  bed  should  be  insisted  upon.  Keep  the 
patient  calm,  as  excitement  increases  the  heart's  action  and  the 
amount  of  blood;  for  the  same  reason  stimulants  should  not  be 
administered.     The  patient  should  be  given  small  pieces  of  ice 


164  APPENDIX. 

to  swallow,  and  teaspoonful  doses  of  vinegar  may  be  given  every 
ten  minutes.  Also  ice-cold  cloths  may  be  placed  over  the 
stomach. 

PIemorrhage  from  the  Lungs  is  usually  caused  by  consump- 
tion and  is  rarely  if  ever  fatal,  except  sometimes  in  the  last 
stages  of  the  disease.  It  is,  therefore,  not  necessary  to  appre- 
hend immediate  death,  as  is  so  often  done. 

Treatment. — The  best  treatment  to  pursue  until  a  physician 
arrives  is  to  place  the  patient  in  a  reclining  position,  but  not 
with  the  head  low,  give  small  lumps  of  ice  to  be  swallowed,  and 
let  him  eat  a  teaspoonful  of  salt  with  the  same  quantity  of 
vinegar.  Salt  absorbs  water  from  the  blood,  and  thus  tends  to 
relieve  hemorrhage  by  thickening  the  blood.  Also,  if  patient  is 
not  too  weak,  cloths  wrung  out  of  ice  water  may  be  applied  to 
the  chest  and  neck. 

Intoxication  is  usually  caused  by  an  excessive  use  of  alco- 
holic beverages.  It  sometimes  resembles  apoplexy?  and  great 
care  should  be  taken  in  determining  the  disease,  as  this  mistake 
has  been  made  with  very  embarrassing  results.  It  should  be 
remembered  that  in  drunkenness  there  is  a  helplessness  on  both 
sides  alike,  but  no  paralysis;  that  there  is  usually  some  sensa- 
tion displayed  by  touching  the  eyeball,  and  that  the  patient 
can  be  aroused  from  the  stupor;  also,  that  the  odor  of  liquor 
can  be  detected  upon  the  breath,  though  this  might  be  the 
case  in  apoplexy. 

Treatment. — A  teaspoonful  of  aromatic  spirits  of  ammonia 
in  a  half  or  two-thirds  of  a  glass  of  water  is  a  useful  corrective 
and  stimulant.  If  this  is  not  at  hand,  a  large  draught  of  vine- 
gar often  does  much  toward  sobering  an  intoxicated  person.  In 
an  extreme  case,  where  respiration  has  ceased,  or  where  there  is 
evidence  of  collapse,  artificial  respiration  should  be  resorted  to, 
heat  should  be  applied  to  the  body,  and  copious  draughts  of  hot 
coffee  should  be  administered. 

Nausea,  if  caused  by  slight  indigestion,  can  usually  be  cor- 
rected by  taking  a  teaspoonful  of  baking  soda  and  the  juice  of 


APPENDIX.  165 

one  lemon  in  a  half  of  a  glass  of  water;  stir  and  drink  while 
foaming-.  Or  take  a  teaspoonfnl  of  aromatic  spirits  of  ammonia 
in  a  third  of  a  glass  of  water.  If  the  nausea  is  due  to  some- 
thing objectionable  to  the  stomach,  the  soda  and  water  will 
usually  give  relief  by  causing  vomiting. 

Poisons. — The  old  maxim,  ''an  ounce  of  prevention  is  better 
than  a  pound  of  cure."  is  surely  applicable  to  the  subject  of 
poisons.  In  the  first  place,  all  dangerous  articles  should  be 
kept  out  of  the  way  of  chiA-ven;  then,  all  bottles,  etc.,  contain- 
ing anything  of  a  toxic  nature  should  be  distinctly  marked 
"poison."  A  very  good  plan  is  to  have  such  bottles  marked  by 
a  ball  and  chain,  which  may  be  procured  at  the  drug  store;  this 
will  give  warning  in  the  dark  as  well  as  in  the  light.  When  it 
is  discovered  that  a  poison  has  been  swallowed,  some  one  should 
be  dispatched  for  a  physician  at  once;  meanwhile,  treatment 
must  be  directed  toward  getting  rid  of  the  poison  before  it 
takes  effect. 

First  admi)uster  a,  prompt  emetic.  Some  poisons,  by  their 
irritating  effect,  naturally  produce  vomiting,  so  that  with  a 
little  encouragement  the  stomach  will  be  thoroughly  evacuated. 
Where  this  is  not  the  case,  the  emetic  will  provoke  expulsion  of 
the  matter.  A  very  good  emetic  for  such  an  emergency  is  luke- 
warm water  in  quantity,  or  a  tablespoonful  of  mustard  or  salt  to 
a  pint  of  warm  water.  As  this  is  no  occasion  for  fastidiousness, 
any  water  that  is  at  hand  may  be  used ;  if  soapy,  and  the  hands 
have  been  washed  in  it,  use  it,  as  by  its  very  repulsiveness  it 
may  act  more  quickly  than  anything  else;  the  patient  should  be 
urged  to  drink  freely  until  he  can  contain  no  more,  and  be 
made  to  vomit  over  and  over  again. 

This  sometimes  leaves  the  patient  much  depressed  in  body, 
and  mind,  showing  signs  of  collapse.  In  such  a  case,  some  mild 
stimulant  may  be  given;  hot  tea  is  probably  one  of  the  best,  as 
it  is  also  a  chemical  antidote  to  many  poisons.  Strong,  hot 
coffee  is  also  good.  To  either  of  these  a  teaspoonful  of  brandy 
may  be  added.     The  patient  will,  of  course,  be  in  bed,  and  it 


166 


APPENDIX. 


should  not  be  forgotten  that  warm  coverings  are  indispensable. 
Hot  bricks  and  hot-water  bags  or  bottles,  may  be  brought  into 
requisition.  Again,  where  it  is  known  that  poison  has  been 
taken,  and  especially  if  it  is  one  of  the  more  active  and  corro- 
sive, an  antidote  to  counteract  the  action  of  the  poison  should  be 
administered  before  or  after  the  emetic.  The  following  list  of 
the  more  common  poisons,  with  their  antidotes,  etc,  will  be 
useful  for  ready  reference. 

SPECIAL   POISONS    AND   READY   ANTIDOTES. 


Poison. 


Acids — Sulphuric,  Nitric,  Aco- 
tic.  Oxalic,  Muriatic,  or  Hy- 
drochloric,     


Alkalies — Potash,  Lye,  Soft 
Soap,  Strong  Ammonia  or 
Hartshorn,     


Arsenic, 


Carbolic  Acid, -■ 


Chloral,   

Chloroform,    Ether,    etc., 


Iodine, 

Lead — Sugar  of  Lead { 

Mercury — Bichloride  of  Mer- 
cury or  "Corrosive  Subli- 
mate,"      


Opium — MorpDine,    Laudanum, 
Paregoric,     


Phosphorus, 


Prussic  Acid,    C 

I 

Silver — Nitrate        of       Silver,    j- 

"Lunar    Caustic,"     | 

Strychnine | 


Treatment. 

Give  an  alkali,  such  as  powdered  chalk, 
plaster,  lime-water,  as  much  as  patient 
can  swallow;  or  lime  scraped  from  the 
plaster  or  white-washed  wall,  stirred  in 
a  cup  of  water.  A  tablespoonful  of 
strong    soapsuds,    etc. 

Give  an  acid — vinegar,  lemon-juice,  sour 
Cider,  etc.  Acids  and  alkalies  neutralize 
each  other — that  is,  combine  to  form 
harmless    salts. 

Milk  or  raw  eggs,  or  flour  and  water,  or 
lime-water  and  oil,  and  after  patient  has 
vomited  freely,  follow  with  a  dose  of 
castor   oil. 

There  is  no  chemical  antidote,  but  the 
stomich  should  be  protected  and  vomiting 
encouraged  by  giving  mucilaginous  drinks, 
flour  and  water,  and  oil  freely — olive,  lin- 
seed,  or   castor. 

Treatment  same  as  opium. 

Loosen  clothing;  sprinkle  cold  water  on  the 
face;  suspend  the  patient  by  the  legs; 
artificial    respiration,    as    for   drowning. 

Starch  and  water;  boiled  or  baked  potatoes. 

Epsom  salts;  after  vomiting  freely,  give 
dose   of  oil. 

Albumen,  uncooked  white  of  eggs,  wheat 
flour,    milk,    etc. 

Induce  vomiting  first.  There  is  no  chemi- 
cal antidote,  but  strong  coffee,  pain,  mo- 
tion, counteract  its  effect.  In  extreme 
cases,  in  addition  to  above  treatment, 
cold  water  should  be  dashed  on  the  face 
and  chest,  and  artificial  respiration  and 
the    battery   resorted    to. 

Provoke  vomiting.  Teaspoonful  doses  of 
turpentine,  mixed  with  magnesia;  but  no 
oil,    it    favors   the   action   of   phosphorus. 

Induce  vomiting  first,  and  give  teaspoonful 
of  ammonia   in  water. 

Large  teaspoonful  or  salt  in  a  glass  of 
water ;    vomiting. 

Induce  vomiting  first;  give  a  purgative; 
secure  absolute  quiet   in  a  dark  room. 


APPENDIX.  167 

There  are  other  poisons,  such  as  Alcohol,  Aconite,  Bella- 
donna, etc.,  which  need  not  be  classified  here,  as  vomiting 
thoroughly,  followed  by  a  mild  stimulant  and  rest,  is  all  that  is 
needed. 

Poisonous  Bites. — By  this  we  mean  bites  of  rabid  or  ven- 
omous animals  and  the  stings  of  insects. 

Snake  Bites. — Tie  a  cord,  or  a  handkerchief  twisted  into 
a  cord,  tightly  around  the  part  just  above  the  wound.  Enlarge 
the  wound  by  making  a  cross  cut  through  the  center  of  the  bite 
with  a  pen  knife.  This  will  encourage  bleeding,  and  will  ex- 
pose the  wound  more  thoroughly  for  the  later  steps  in  treat- 
ment, which  are  as  follows:  Draw  the  poison  from  the  wound 
by  means  of  suction  with  the  mouth,  unless  the  mouth  be  sore, 
or  by  taking  a  wide-mouthed  bottle,  and  after  saturating  a 
piece  of  cotton  or  paper  with  alcohol  or  benzine,  set  it  on  fire 
and  dip  it  into  the  bottle.  As  soon  as  the  flames  begin  to  die 
out,  quickly  invert  the  bottle  over  the  wound  and  press  tightly 
against  the  skin  to  prevent  the  admission  of  air.  This  will  ex- 
tract the  venom  and  blood  from  the  exposed  vessels.  Then  heat 
a  knitting  needle,  a  piece  of  wire,  or  small  blade  of  a  knife  to  a 
white  heat,  and  thrust  it  into  the  wound.  At  the  same  time 
large  doses  of  whisky  or  brandy  should  be  given  and  the  patient 
kept  under  the  influence  of  the  stimulant  until  medical  aid 
can  be  secured.  Some,  however,  prefer  to  use  aromatic  spirits 
of  ammonia  instead  of  whisky,  one  drachm  to  a  wineglassful 
of  water. 

Mad  Dog  Bites. — There  are  some  physicians  who  claim  that 
there  is  no  such  disease  as  hydrophobia;  one  author  puts  it  in 
this  way:  "So-called  hydrophobia  exists  exactly  in  proportion 
to  the  common  belief  in  it,"  that  is  to  say,  the  trouble  is  alto- 
gether mental.  There  is  no  doubt  but  that  a  great  many  deaths 
have  been  caused  by  fright  and  anxiety,  but  that  all  cases  are 
spurious  we  are  not  prepared  to  believe,  and  think  that  prompt 
and  heroic  treatment  should  always  be  given. 


168  APPENDIX. 

As  dogs  are,  with  many  i^ersons,  daily  companions,  it  is  im- 
portant to  know  the  various  symptoms  of  madness.  The  fol- 
lowing is  a  resume  of  the  instructions  issued  by  the  Council  of 
Hygiene,  of  Bordeaux. 

Signs  of  Madness  ix  Dogs. — "1.  A  short  time  after  the  dis- 
ease has  been  contracted,  the  dog  becomes  agitated  and  restless, 
and  turns  continually  in  his  kennel.  If  unchained,  he  roams 
about  aimlessly;  he  seems  to  be  seeking  something;  then  stands 
motionless,  as  if  waiting;  he  starts,  snaps  at  the  air,  as  if 
catching  a  fly,  and  dashes  himself,  barking  and  howling,  against 
the  wall.  The  voice  of  his  master  recalls  him  and  he  obeys,  but 
slowly,  with  hesitation  and  seeming  regret. 

"2.  He  does  not  try  to  bite,  is  gentle,  even  affectionate,  and 
eats  and  drinks ;  but  gnaws  his  litter,  the  ends  of  the  curtains, 
the  padding  of  cushions,  bed-coverlids,  carpets,  and  anything 
which  happens  to  be  in  his  reach. 

"3.  From  the  movement  of  his  paws  along  the  ^des  of  his 
open  mouth,  one  might  suppose  him  trying  to  free  his  throat  of 
a  bone. 

"4.  His  voice  is  changed  so  markedly  that  it  is  impossible 
to   overlook   it. 

"5.     He  becomes  surly,  and  begins  to  fight  with  other  dogs." 

The  symptoms,  however,  vary  in  different  cases,  and  a  change 
in  the  habits  or  manner  of  a  pet  dog  should  always  be  looked  on 
with  suspicion,  and  the  animal  should  be  chained  for  a  while. 

The  probability  of  hydrophobia  being  communicated  to  per- 
sons bitten  by  a  mad  dog  varies  with  the  location  of  the  bite. 
If  it  be  in  a  part  unprotected  by  clothing,  inoculation  is  almost 
certain  ;•  in  other  parts,  the  chances  depend  on  the  thickness  of 
the  clothing,  which  wipes  the  virus  from  the  teeth. 

Treatment. — The  treatment  in  case  of  mad  dog  bite  must  be 
altogether  preventive,  as  after  the  specific  symptoms  manifest 
themselves  the  only  thing  to  do  is  to  keep  the  patient  quiet  by 
the  administration  of  hypnotics,  until  death  ensues.     But  this, 


APPENDIX.  160 

of  course,  belongs  to  the  physician.  When  one  is  bitten  by  a 
rabid  dog,  the  same  course  should  be  pursued  as  directed  for 
snake  bite,  excepting  the  stimulants.  Then  start  at  once  for  a 
hospital,  where  the  patient  can  receive  Pasteur's  treatment  'by 
inoculation. 

Bites  and  Stings  of  Insects. — Despite  the  current  belief 
that  the  bite  of  a  tarantula,  centipede,  and  other  insects  are 
dangerous  to  life,  experience  proves  that  they  are  in  nearly  all 
cases  comparatively  harmless,  causing  only  temporary  pain 
and  annoyance. 

Treatment. — They  may  be  treated  with  cold,  wet  applications; 
if  nothing  better  is  at  hand,  wet  earth  is  good.  The  application 
of  a  few  drops  of  hartshorn  at  the  point  where  the  sting  entered 
will  also  give  relief.  It  sometimes  happens  that  a  wasp  or  bee 
is  swallowed  in  taking  a  drink  of  water  hurriedly  in  the  dark. 
In  such  cases  the  fauces  swell  rapidly  from  the  moment  the 
sting  enters  the  throat,  which  places  the  patient  in  danger  of 
suffocation.  This  should  be  treated  by  the  free  use  of  a  gargle 
of  hot  water  and  salt,  pending  the  physician's  arrival. 

Sea-Sickness. — Sickness  occasioned  by  the  motion  of  a 
vessel  at  sea  is  often  most  distressing.  The  most  efficient  pre- 
ventive or  treatment  is  to  take  a  seat  near  the  center  of  the 
vessel  (if  inclined  to  keep  up)  and,  as  the  ship  descends,  take  a 
full  breath;  wear  a  wide  firm  belt  around  the  stomach,  eat 
lightly,  plainly  and  often;  if  the  stomach  is  much  disturbed, 
take  the  juice  of  one  lemon  in  half  a  glass  of  water,  with  one 
tea  spoonful  of  baking  soda;  stir  and  drink  while  foaming. 

Sprains. — A  sprain  is  a  sudden  overstretching  and  tearing 
of  the  ligaments  which  enter  into  the  formation  of  a  joint,  as 
w^ell  as  the  tendons  and  muscles  about  the  joint. 

Treatment. — The  joint  should  be  soaked  in  water  as  hot  as 
the  patient  can  bear  for  twenty  minutes  or  more,  then  rub 
gently  with  cosmoline,  and  apply  a  snugly  fitting,  but  not  tight, 
flannel  bandage,  and  give  the  part  as  near  perfect  rest  as 
possible. 

13 


170  APPENDIX. 

'  Starvation. — When  a  person  is  found  exhausted  from  starv- 
ation, he  should  be  placed  in  a  comfortable  position  and  given 
stimulating,  fluid  food.  Warm  milk,  soup,  and  hot  coffee  are 
among  the  best,  given  a  little  at  a  time,  but  often. 

Strangulation. — In  cases  of  strangulation — ^that  is,  com- 
pression of  the  windpipe  from  the  outside,  as  in  hanging,  etc.— 
the  treatment  to  be  pursued  is  to  remove  the  pressure  at  once, 
and  re-establish  the  respiration,  as  in  drowning. 

Suffocation. — Suffocation  from  foul  air,  noxious  gases,  etc., 
is  caused  by  a  poisonous  gas  known  as  carbonic  acid.  When  it 
is  desirable  to  enter  a  cellar,  well,  mine,  etc.,  where  there  is  a 
suspicion  of  foul  air,  a  thorough  examination  should  be  made. 
Man  can  not  live  in  an  atmosphere  where  a  candle  will  not  burn, 
animal  life  and  flame  being  both  supported  by  oxygen.  The 
best  test,  therefore,  is  to  lower  an  unprotected  light  where  foul 
air  is  suspected;  if  the  flame  flickers  and  goes  out,  by  no  means 
enter.  # 

Carbonic  acid  gas,  being  heavier  than  air,  can  readily  be  re- 
moved by  the  use  of  a  pump,  but  if  this  is  not  at  hand,  quick 
lime  (lime  freshly  burned),  scattered  about  in  large  quantities, 
will  accomplish  the  purpose. 

Treatment. — In  case  of  asphyxiation  from  noxious  vapors  the 
patient  should  be  removed  as  soon  as  possible  to  fresh  air,  and 
natural  respiration  re-established,  as  directed  for  drowning. 

Sun  Stroke  does  not  necessarily  arise  from  undue  exposure 
to  the  direct  rays  of  the  sun,  but  may  proceed  from  a  prolonged 
elevation  of  the  bodily  temperature,  or  from  excessive  heat  en- 
countered when  the  vital  forces  are  near  the  point  of  exhaustion. 
It  is  generally  preceded  for  some  time,  usually  from  one  to 
three  days,  by  pain  in  the  head,  a  feeling  of  weakness,  disturb- 
ance of  the  sight  and  nausea.  This  attack,  however,  culminates, 
usually  after  the  third  day,  in  a  loss  of  consciousness.  The  skin 
is  intensely  hot  and  dry,  the  temperature  rising  as  high  is  112. 
In  fevers,  if  the  temperature  rises  to  105  or  106,  it  is  considered 


APPENDIX.  1 7  ] 

a  severe  case.  It  is,  therefore,  apparent  that  the  patient  is  suf- 
fering from  an  excess  of  heat  in  the  body.  The  thing  to  be 
done,  then,  is  to  lower  the  temperature  as  soon  as  possible. 
Every  minute  being  valuable,  the  following  treatment  should 
be  pursued: — 

Treatment. — Send  some  one  for  a  physician.  Remove  as 
much  of  the  clothing  as  possible,  and  place  the  patient  in  a 
cool  and  airy  place,  indoors  or  out.  Cold  must  then  be  applied 
to  the  head  and  body,  not  dashed  or  sprinl^led,  as  that  would 
only  cause  a  needless  shock;  but  towels  wrung  out  of  ice-water, 
and  frequently  renewed,  should  be  placed  upon  the  head,  cracked 
ice  placed  in  the  arm-pits,  and  the  body  may  be  wrapped  in 
cold,  wet  blankets.  Continue  this  treatment  until  the  physician 
arrives  or  the  patient  shows  signs  of  consciousness,  then  discon- 
tinue, unless  consciousness  should  again  be  lost  or  the  surface 
of  the  body  becomes  very  hot.  Never  in  such  cases  administer 
a  stimulant. 

Wounds. — In  surgery,  wounds  are  divided  into  three  classes 
according  to  their  cause,  namely,  incised^  lacerated  and  con- 
tused. There  is  a  subdivision  of  this  classification,  of  course, 
but  this  is  all  that  is  necessary  for  our  present  purpose. 

Incised  Wounds  are  those  made  by  sharp-cutting  instru- 
ments, making  what  are  called  clean  cuts;  that  is,  there  is  no 
tearing  or  bruising,  but  the -edges  are  clean  cut  and  the  surface 
smooth. 

Treatment. — If  the  wound  is  simple  and  small,  the  only 
treatment  that  is  required  is  to  cleanse  the  edges  and  apply  ad- 
hesive plaster  and  perhaps  a  bandage.  But  where  the  wound  is 
more  extensive  and  serious,  the  edges  should  be  brought  firmly 
together,-  if  possible,  and  held  in  that  position  by  adhesive  plas- 
ter and  bandages.  But  when  this  will  not  answer,  hold  the  parts 
together  with  the  hands  until  the  physician  arrives.  Dr.  Dulles 
says :  "In  case  an  entire  part  be  cut  off,  as  an  ear,  or  a  nose,  or 
a  toe,  or  a  finger,  it  should  be  cleansed  with  lukewarm  water 


172  APPENDIX. 

and  put  in  its  place,  leaving  to  the  surgeon  the  decision  whether 
or  not  it  would  be  worth  while  to  try  to  save  it.  Some  very 
remarkable  cases  of  reunion  of  such  parts  are  in  record,  and  an 
attempt  to  save  them  is  not  to  be  lightly  rejected." 

Lacerated  Wounds  are  made  by  blunt  tearing  instruments, 
such  as  dull  tools,  pieces  of  machinery,  nails,  hooks,  etc.  These 
wounds  are  rough  and  ragged  and  usually  bleed  but  little.  They 
should  be  given  surgical  skill,  but  until  this  can  be  secured  the 
torn  parts  should  be  cleansed  by  a  stream  of  lukewarm  water, 
then  brought  as  near  to  their  natural  position  as  possible  and 
covered  with  a  cloth  soaked  in  lohenol  sodique,  tincture  of  mari- 
gold, or  laudanum,  and  wrapped  lightly.  If  no  good  remedy  is 
at  hand,  wrap  in  cloth  wrung  out  of  cold  water.  If  the  patient 
seems  much  depressed,  administer  a  little  brandy  or  wine. 

Contusions  are  what  are  commonly  known  as  bruises;  they 
are  usually  caused  by  some  blunt  instrument  or  a  fall;  the  skin 
is  not  torn  through,  but  is  often  discolored,  which  is  dfue  to  the 
rupture  of  the  capillaries,  allowing  the  blood  to  escape  into  the 
surrounding  tissues — the  familiar  black  and  blue  appearance 
of  a  bruise. 

Treatment. — Such  wounds  are  best  treated  by  directing  upon 
the  wounded  part  a  stream  of  water,  as  hot  as  the  patient  can 
bear  it,  for  several  minutes.  This  will  favor  the  carrying  off 
of  the  escaped  blood.  Then,  after  bathing  the  part  freely  with 
phenol  sodique  or  laudanum,  wrap  in  hot,  wet  cloths. 

WEIGHTS  AND  MEASUKES. 

APOTHECARIES'    WEIGHT. 

20  grains  (gr.)  make  1  scruple, sc.  or    9 

3  scruples  make  1  drachm, dr.  or  3 

8  drachms         make  1  ounce, oz.  or  § 

12  ounces  make  1  pound, lb.  or  It) 

SCALE    OF     COMPARISON. 

Xb                         oz.          dr.           sc.  gr. 

1     =     12     =:     96     =     288  =  5760 

1     =      8     =      24  =  480 

1     =       3  =  60 

1  =  20 


APPENDIX. 


173 


APOTHECARIES'    OR   WINE   MEASURE. 

60  minims  ci]-^)     make  1  fl.  draclim fl.   dr.   or  tc 

8  Jl.   drachms      make  1  fl.  ounce,  fl.  oz.   or  fg 

16  fl.   ounces         make  1  pint.  O. 

S  pints  make  1  gallon, C. 

SCALE     OF     COMPABISON. 


Gallon. 

Pints. 

Fl.  ounces. 

Fl 

.  drach 

ms. 

Minims. 

C. 

1 

0. 

8 

=    128 

_ 

1024 

_ 

61440 

1 

=     16 

=r 

128 

— 

7680- 

1 

= 

8 

1 

=^ 

480 
60 

TROY   WEIGHT. 

24  grains  (gr.)       make  1  pennyweight,  dwt. 

20  pennyweights  make  1  ounce,  oz. 

12  ounces  make  1  pound,  lb 

3%  grains  make  1  carat    (diamond   weight), k. 


m- 

1 


SCALE 

OF 

COMPARISON. 

OZ. 

dwt. 

12 

z= 

240 

1 



20 

1 
Ik. 

gl". 

5760 

480 
24 
3% 


AVOIRDUPOIS   WEIGHT. 

16  drachms  idr.)    make  1  ounce, oz. 

16  ounces  make  1  pound, lb. 

25  pounds  make  1   quarter qr. 

4  quarters  make  1  hiindredweight, cwt. 

20  hundredweight  make  1  ton,  T. 

100  pounds  make  1  cental, C. 


SCALE 

OF 

COMPARISON. 

T. 

cwt. 

qr. 

lb. 

oz 

dr. 

1   = 

=   20 

=: 

SO 

= 

2000 

= 

32000 

— 

512000 

1 

= 

4 

= 

100 

= 

4000 

■ — 

25600 

1 

^ 

25 

1 

= 

400 

16 

] 

— 

6400 

256 

16 

A  gallon  contains  eight  pints. 

A  pint    contains   sixteen   fluid   ounces. 

A  fluid  ounce  contains  eight   fluid   drachms. 

A  fluid  drachm  contains  sixty  minims   (Tn)- 


174 


APPENDIX. 


APPROXIMATE  MEASUEEMENT, 

A  wineglass   contains  two  fluid  ounces. 

A  teacup   contains  four  fluid  ounces. 

A  teaspoon  of  powder  contains  one-half  drachm. 

A  tablespoon  of  powder   contains  two   drachms. 

One  drop  of  essential   oils   contains  one-half  minim. 

One  drop  of  water  contains  one  minim. 

From  Oould's  Medical  Dictionary. 

The  following  table  of  approximate  and  exact  equivalents  of 
the  metric  and  common  weights  and  measures  may  prove 
serviceable : 


Unit    of   Measurement. 


1  inch, 

1  centimeter 

1  yard, 

1   meter    (3D. 37 

1  foot,  

1  kilometer    (1000   meters), 
1  mile, 


(Vioo  meter), 
inches). 


Approximate  Equivalent. 

2  ^2     cubic    centimeters, 

0.4     inch, 

1    meter, 

1    yard, 

30    centimeters, 

%     mile, 

1%     kilometer. 


Accurate 
Equivalent. 
2.539 
0.393 
0.914 
1.093 
30.479 
0.621 
1.609 


SUEFACE. 


Unit    of    Measurement. 


1  hectare 
1  acre. 


(10,000   sq.   meters). 


Approximate  Equivalent. 
2%     acres, 
Yg    hectare. 


Accurate 

Equivalent. 
.  .  2.471 
.      .      0.404 


WEIGHT, 

Accurate 

Approximate  Equivalent.     Equivalent. 

.    151/2     grains, 15.432 

.  0.064  gramme,  ....  0.064 
.  2y.  lbs.  avoirdupois,  .  .  2.204 
%  kilogramme,  ....  0.453 
ounce,  Troy  or  apothecary  (480  28^/3  grammes,  ....  28.349 
grains),  31    grammes, 31.103 


Unit    of    Measurement. 

gramme, 

grain, 

kilogramme    (1000    grammes), 
pound    avoirdupois,        .      .      .      . 
ounce  avoirdupois   (437%  grains) 


BULK. 

Unit    of    Measurement. 

Approximate  Equivalent. 

1  cubic    centimeter 0.06    cubic    inch,     . 

1   cubic    inch,         l^y^   cubic   centimeters, 

1  liter    (1000   cubic  centimeters),    .   1  IT.   S.   Standard  quart, 
1  United   States   quart,    ...         1    liter,         .... 
1  fluid    ounce 29%    cubic   centimeters, 


Accurate 

Equivalent. 

0.061 

16.386 

0.946 

1.057 

29.570 


INDEX. 


Abbreviations,   8. 
Abrasion  of  the  teeth,  50. 
Abscesses,  34. 

Alveolar,   34,   63. 
of  the  antrum  of  Highmore,  62. 
Absorption  of  roots,  27. 
Acetic  acid,  130. 
Acids,   antidotes  for.   166. 
burns  from,   148. 
their  effect  upon  the  teeth,  TA. 
Aconite,  78. 

Acute   inflammation,    30. 
Adrenalin,  126. 
Alcohol,  98. 
Alkalies,  166. 

antidotes  for,  106. 
Alum,    125. 

xVlveolar  abscesses,  34. 
Alveolaris  pyorrhoea,  43. 
Amelloblasts  10. 
Ammonia,  100. 
Amyl  nitrite,  102. 

Anesthesia,  treatment  of  dangerous 
dangers  of,  85. 
symptoms  in,  95. 
stages  of,  80. 
Anesthetics,  general,   79. 

local,  82,  93. 
Analgesics,   76. 
Anatomy  of  the  teeth,  19. 
Anemia,   29. 

Angel's  method  of  fixation,  59. 
Anodynes,    76. 
Anomalies  of  the  teeth,  28. 
Antacids,   146. 
Antidotes,   166. 
Antipyretics,    119. 
Antipyrine,   119. 
Antiseptic  mouth-washes,  45. 
Antiseptics,  131. 
Antizymotics,  131. 


Antrum    of   Highmore,    diseases  of, 

62. 
Apoplexy,   148. 
Aristol,  137. 
Arsenic,  112. 

Articulation  of  the  teeth,  23. 
Artificial    palates,    67. 
respiration,   153. 
Astringents,    123. 
Atropine,  78. 

B. 

Bandages,   158. 
Belladonna,  78. 
Bicarbonate  of  soda,   146. 
Bichloride  of  mercury,   132. 
Bites,  dog,  167. 

serpent   and   insect,    169. 
Bleeding,  161. 
Blood  stasis,   34. 
Borax,   146. 
Bromide  of  ethyl,  91. 
Bromine,  bromides,  75. 
Bruises,  172. 
Burns,   148. 

c. 

Calcareous  deposits,  69. 
Calcification  of  the  pulp,  16. 

of  the  teeth,  13,  15. 
Campho-phenique,   141. 
Camphor,  101. 
Capsicum,  103. 
Carbolic  Acid,  129. 
Caries  in  relation  to  sex,   52. 

of  the  teeth,  49-55. 
Caries,  relative  location  of,  55. 

therapeutics  of,   56. 
Catalepsy,  149. 
Cathartics,  143. 


175 


176 


INDEX. 


Caustics,  127. 
Cementoblasts.  13. 
Cementum,   13,   14. 
Chemical  irritants,  120. 
Chloral,  76. 
Chloride  of  ethyl,  95. 

of  zinc,  114. 
Chloroform,   86. 

mortality,    87,    88. 

physiological  action,  S8. 

therapeutic  uses  of,  87. 
Choking,  150. 
Chronic  inflammation,    30. 
Cimicifuga,  109. 
Cinchona,  106. 
Cinnamon,  141. 
Citrate  of  magnesia,  143. 
Classification   of   tue  teeth,   19.    20. 
Cleaning  teeth,   72. 
Cleft  palate,  65. 
Cloves,   oil  of,   104. 
Cocaine,  93. 
Collodion,   145. 
Congestion,  33. 
Contusions,   172. 
Convulsions.  150. 

in  teething,  25. 
Corn  ergot,   127. 
Corrosive  sublimate,   l'o2. 
Creasote,  139. 
Crowns  of  teeth,  21. 
Cuts,  171. 
Cystic    tumors,    38. 

D. 

Dangers  of  anesthesia,  85. 
Deaths  from  teething,  25. 
Deciduous  teeth,   decalcification  of. 
25. 

germination  of,  10,  11. 
Defects  of  the  palatine  organs,   65. 
Dental  Abrasion,  56. 

caries,  49-55. 

relative  location  of,  55. 
Dental    caries,   therapeutics   of,    56. 

erosion,   46. 

medicine,   74. 

pathology,  29. 

periostitis,  42. 

pulp,  16,  17. 

therapeutics,   29. 


Dentinal  fibrils,  13. 
Dentine,  14. 

calcification   of,   13,   14. 

formations,  40. 

organ,  10. 
Dentition,  23. 

lesions  incident  to,  24. 

second,  27. 

third,  28. 
Denture,  permanent,  17. 

temporary,    17. 
Deposits  upon  the  teeth,  69. 
Development   of  teeth,   9,   10. 
Devitalization  of  pulp,  39. 
Digitalis,  108. 
Disease.   29. 

Diseases  of  dental   pulp   and  meip- 
brane,   38. 

of  hard  dental  structure,  49. 

of  maxillary  bones,  57. 
Disinfectants,  131. 
Dislocation    of    the    inferior    maxil- 
lary, 61. 

treatment  of,  62. 
Dislocations,   150. 
Dover's   powders,    77. 
Drowning,   treatment  of.   151. 
Drugs,  miscellaneous.  144. 

E. 

Electrozone,  142. 
Emergencies,  148. 
Enamel,  9,  14. 

calcification  oi,  12. 

formation    of.    9,    11. 

organ,  9. 
Enamelblasts.  10. 
Epilepsy,  treatment  of,  155. 
Epithelium,  9. 
Epsom  salts,  143. 
Epulis  tumors,  33. 
Ergot.  127. 

Erosion,  dental,  46,  4  4'. 
Eruption  of  the  teeth,   23,  27. 
Escharotics,  127. 
Ether,  82. 

action  of,   82,   84. 

administration  of,  83. 

mortality,    88. 

physiological  action,  88. 


INDEX. 


177 


Ethyl   bromide,    91. 

chloride,  95. 
Etiology  of  dental  caries,  50. 
Bucaine   hydrochlorate,    '"A,"   Uil 
Eucalyptus,   109. 
Eugenol,  104. 

Exhaustion  from  heat,  155. 
Exostosis,  47,  48. 
Exposed  pulp,  39. 
Extraction  of  teeth,  07. 

hemorrhage   following,    GO. 

indications    justifying,    07,    OV. 

F. 

Fainting,   158. 

Ferrum,   111. 

Fistula,   34. 

Follicles  of  the  teeth,  11,  12. 

Foreign  bodies  in  the  throat,  150. 

Formalin,  138. 

Formula  of  permanent  teeth,  20. 

of  temporary  teeth,   19. 
Fowler's  solution,   112, 
Fractures,  158. 

of  alveolar  process,  57. 

of  maxillae,  57. 

treatment    of,    58. 
Freezing,  160. 

gum  before  extracting,  95. 

G. 

Gallic  acid,  124. 
Gangrene  of  the  pulp,  42. 
Gas,  administration  of,   89. 

liquefied,  90. 
Gas,   mortality  of,   91. 

nitrous  oxide,  89. 
Gases,    noxious,   170. 
Gaultheria,   139. 
Germination    of   the    teeeth,    9. 
Glacial   phosphoric   acid,    118. 
Glycerin,   144. 
Green  stain,   09. 

H. 

Hard  dental   structure,   diseases  of, 

49. 
Heat-stroke,   155. 
14 


Hemorrhage,  IGl. 

after  extraction,   09,  103. 

from  lungs,  1G4. 

from  nose,  162. 

from  stomach,  1G3. 
Hemostatics,   12G. 
Hutchison  teeth,  54. 
Hydrochloric   acid,   118. 
Hydrogen  peroxide,  133. 
Hydrophobia,  1G7. 

treatment  of,    x^6. 
Hypercementosis.    47,    48. 
Hyperemia,  29. 
Hypertrophy,  31. 

of  the  pulp,  40. 
Hypnotics,  74. 


Incised  wounds,  171. 
Induration,  32. 
Inflammation,    29. 

acute,  30. 

chronic,    30. 

of  the  pericemental  membrane, 
42,  43. 

of  the  pulp,   38. 

of  the  temporo-maxillary  artic- 
ulation,   61. 
Injuries   and   diseases  of  maxillary- 
bones,  56. 
Interdental  splints,  58,  59. 
Interglobular  spaces,  14. 
Intoxication,   164. 
Iodine,  121. 
Iodoform,   130. 
Iron,   111. 
Irritants,  120. 
Irritation  of  pulp,  17. 
Ischemia,   29. 

L. 

Lacerated  wounds,   172. 
Lancing  of  gums,  25. 
Laxatives,  142. 
Lime   Water,   146. 
Lunar  caustic,  128. 

M. 

Magnesia,   143. 

Materials  used  for  splints,   160, 


178 


INDEX. 


Maxillary  bones,  diseases  and  inju- 
ries of,  56. 
Mechanical  irritants,  120. 
Medicine,  dental,  74. 
Membrane,    pericemental,    17. 
Miscellaneous   drugs,   144. 
Monsel's  solution,   111. 
Morphine,  77. 
Mouth-washes,  56. 
Mucous  deposits,  70. 

effects  of,   upon   the  teeth,   70. 
Myrrh,  103. 

N. 

Naphthol,    140. 

Narcotics,  74. 

Nausea  treatment  of,  164. 

Necrosis  of  the  jaws,   59. 

Nervous  irritants,  121. 

Nitrate  of  Amyl,  102. 

Nitrate  of  silver,  128. 

Nitric  acid,  117. 

Nitrite  of  amyl,  102. 

Nitrous  oxide  as  an  anesthetic,  89. 

manner  of  preparation  of,  89. 

mode  of  administering,   70. 

mortality  of,  91. 
Nodular  dentine,  41. 
Nut-galls,  123. 
Nutrition  of  the  teeth,  18. 
Nux  vomica,   107. 

0. 

Obturators,  68. 
Occlusion  of  the  teeth,  23. 
Odontalgia,  56. 
Odontoblasts,  13. 
Oil  of  cloves,  104. 

of  eucalyptus,  109. 
Opium,  77. 
Organ,  dentine,   10. 

enamel,   9. 
Osteodentine,  41. 
Oxychloride  of  zinc,  115. 
Oxyphosphate  of  zinc,  115. 


Pain  after  filling,  40. 
Palates,  artificial,  67. 


I'alatine  organs,  defects  of,  65. 
Pajiilla,   dentinal,   10. 
Paralysis,  148. 
Pathology,    dental,   29. 
Peppermint,  105. 
Pericementitis,  42,  43. 
Peridental   membrane,   17. 
Permanent  denture,  19. 

tooth  follicles,  12. 
Permanganate  of   potassa,   135. 
Peroxide  of  hydrogen,  133. 

of  sodium,  135. 
Persulphate  of  iron,  11. 
Peruvian  bark,  106. 
Phenol  sodique,  130. 
Phosphoric  acid,  113. 
Physical      effects      of      anesthesia, 

84,  88. 
Physiology  of  the  teeth,  14. 
Pitted  teeth,  53. 
Plethora,  29. 
Poisons    and    their    antidotes,    165, 

166. 
Polypus,  40. 
Prepared  chalk,  147. 
Primary  dentition,   23.    - 
Prophylaxis,  56. 
Proximal  surfaces,  5o. 
Pulp,  calcification  of,  16. 

devitalization   of,   39. 

diseases  of,  38. 

exposure   of,    39. 

gangrene  of,  42. 

hypertrophy   of,   40. 

inflammation  of,  38. 

irritation  of,  17. 

nodules,   41. 

structure    of,    16,    17. 
Pulpitis,  43. 
Purgatives,   137. 
Pus  and  pus  formation,  31. 
Pyorrhoea   alveolaris,   43. 
Pyrozene,  134. 


Quinine,  116. 


R. 


Removal  of  temporary  teeth,  25. 
Resolution,   31. 


INDEX. 


179 


Kespiration,    artificial,    153. 
Resuscitation  from  drowning,  151. 
Rhubarb,  143. 

S. 

JSaliva,  70. 

ISalivary   calculus,    69,    70. 

composition  of,  70. 
Sandarach,   145. 
Sanguinary    calculus,    72. 
Scalds,   treatment  of,   148. 
Sea-sickness,    169. 
Second  dentition,  27. 
Secondary  dentine,  40. 
Sedatives,    119. 
Senna,  143. 

Shedding  of  temporary   teeth,  215. 
Silver  nitrate,  128. 
Snake  bites,  167. 
Sodium  chloride,  105. 
Sodium   peroxide,    135. 
Splints,  59,   160. 
Sprains,    169. 
Staphylorrhaphy,  66. 
Starvation,   170. 
Stimulants,  98. 
Stomalitis,   37. 
Strangulation,   170. 
Structure  of  the  pulp,   16. 

of  the  tfeth,  14. 
Strychnine,    107. 
Styptics,   126. 
Suffocation  from  gas,  170. 
Sulphate  of  iron,  112. 

of  magnesia,  143. 
Sulphuric  acid,  116. 

aromatic,    116. 
Sun-stroke,  treatment  of,  170. 
Supernumerary   teeth,    28. 
Suppuration,   31. 
Surface  of  teeth,   21,  22. 


T. 


Tannic  acid.   123. 


Tartar    of    salivarj'    calculus,    69. 
Teeth,  anatomy  of,  19. 

articulation  of,  23. 

calcification  of,  13,  15. 

cementum  of,  14. 

classification  of,  19,  20. 

crowns  of,  21. 

decalcification  of,  25. 

dentine  of,   14. 

development   of,    9. 

enamel   of,   9,   13. 

eruption  of,  23,   27. 

extraction    of,    67. 

follicles  of,   12. 

germination  of,  9. 

occlusion  of,  23. 

permanent,    eruption   of,    27. 

primary,  eruption  of,  23. 

pulp  of,  16. 

relative     proportion     of     roots 
and  crowns  of,  21. 

structure  of,  14. 

supernumerary,    28. 

surfaces  of,  21. 

temporary,  23. 

absorption   of,   25. 
Teething,  24. 

convulsions   in,    25. 

deaths  from,   25. 

treatment  during,   25. 
Temporary   denture,   19. 
Therapeutics,  29. 

of  caries,  56. 
Third  dentition.  28. 
Tonics,  106. 
Tooth  powder,  56. 

pulp,  16. 
Trichloracetic  acid,    131. 
Tumefaction,   33. 
Turpentine,   122. 


U. 


Ulceration,  34. 

I'se  of  tooth-brushes,   56. 


180 


IMjEX. 


Vascular   tumors,    33. 
Velum,  artificial,   67. 
Vomiting,  to  allay,  164. 
to  produce,  165. 

W. 

Weights  and  measures,  172,  173. 


Wounds,  contused,  171. 
incised,    171. 
lacerated,  172. 

Z. 

Zinc,  114. 

chloride,  114. 
oxychloride  of,  115. 
oxyphosphate  of,  115. 


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